Provider Demographics
NPI:1255455887
Name:MARGARET MOEN MD PLLC
Entity type:Organization
Organization Name:MARGARET MOEN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-935-8889
Mailing Address - Street 1:457 MUNSON AVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3084
Mailing Address - Country:US
Mailing Address - Phone:231-935-8889
Mailing Address - Fax:231-935-0540
Practice Address - Street 1:457 MUNSON AVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3084
Practice Address - Country:US
Practice Address - Phone:231-935-8889
Practice Address - Fax:231-935-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMM050642207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2084N0400XOtherTAXONOMY
MI1336230481OtherINDIVIDUAL NPI
MI4594192Medicaid
MI124729OtherPREFERRED CHOICES
MIMM050642OtherSTATE LICENSE
MIQMXPR0026631OtherMOLINA
MI$$$$$$$$$OtherSOCIAL SECURITY NUMBER
MI1302810101OtherBCBSM
MI1014033OtherNHP
MIP00116249OtherRR MEDICARE
MIP00116249OtherRR MEDICARE
MI1336230481OtherINDIVIDUAL NPI
MIB85088Medicare UPIN