Provider Demographics
NPI:1245727403
Name:CARL K. MOSHOVITIS, M.D., S.C.
Entity type:Organization
Organization Name:CARL K. MOSHOVITIS, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOSHOVITIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-708-4846
Mailing Address - Street 1:PO BOX 2876
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-6876
Mailing Address - Country:US
Mailing Address - Phone:847-864-6666
Mailing Address - Fax:847-864-0088
Practice Address - Street 1:7126 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-2234
Practice Address - Country:US
Practice Address - Phone:847-864-6666
Practice Address - Fax:847-864-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036077963207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty