Provider Demographics
NPI:1952389231
Name:MOSES, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MOSES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 MONROE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3057
Mailing Address - Country:US
Mailing Address - Phone:313-481-1030
Mailing Address - Fax:313-481-1031
Practice Address - Street 1:2142 MONROE ST STE 100
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3057
Practice Address - Country:US
Practice Address - Phone:313-481-1030
Practice Address - Fax:313-481-1031
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDM048222207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI364509477OtherTAX ID
MI4944657Medicaid
MI4793786Medicaid
MI160H229520OtherBCBSM
MI4299391OtherAETNA
MI364509477OtherTAX ID
MIOP48480Medicare PIN
MI160H229520OtherBCBSM
MI4299391OtherAETNA