Provider Demographics
NPI:1154589257
Name:MOORE, MICHAEL CONDI CT (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CONDI CT
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:825 NICOLLET MALL STE 1950
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2707
Mailing Address - Country:US
Mailing Address - Phone:612-339-0738
Mailing Address - Fax:612-321-0985
Practice Address - Street 1:825 NICOLLET MALL STE 1950
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2707
Practice Address - Country:US
Practice Address - Phone:612-339-0738
Practice Address - Fax:612-321-0985
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN249052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry