Provider Demographics
NPI:1740469873
Name:RAYMOND W. MOY MD SC
Entity type:Organization
Organization Name:RAYMOND W. MOY MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOKELKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-545-7245
Mailing Address - Street 1:6917 W OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2973
Mailing Address - Country:US
Mailing Address - Phone:414-545-7245
Mailing Address - Fax:414-545-3373
Practice Address - Street 1:6917 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-2973
Practice Address - Country:US
Practice Address - Phone:414-545-7245
Practice Address - Fax:414-545-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21142207Q00000X, 2084A0401X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30254700Medicaid
WIB55241Medicare UPIN
WI000101451Medicare PIN
WI30254700Medicaid