Moen, Michael D

Moen, Michael D is an individual health care provider with primary practice located at 1875 Dempster St Suite 665, Park Ridge IL 60068. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Gynecology, Allopathic & Osteopathic Physicians / Female Pelvic Medicine and Reconstructive Surgery. Allopathic & Osteopathic Physicians / Female Pelvic Medicine and Reconstructive Surgery is his primary health care specialty. Moen, Michael D can be contacted via phone (847) 825-1590.

Contact Information

Primary practice address
1875 Dempster St Suite 665 Park Ridge IL 60068
Phone: (847) 825-1590
Fax: (847) 825-1604
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gynecology 207VG0400X 036083401 Illinois
Allopathic & Osteopathic Physicians / Female Pelvic Medicine and Reconstructive Surgery 207VF0040X 036-083401 Illinois

Profile Details

NPI number 1558351312
LBN Legal business name Moen, Michael D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 24th, 2005
Last updated Aug 8th, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558351312 NPPES
Illinois MEDICAID 036083401

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