# KEITH A. MOSS, M.D., SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154520112
- **Authorized official:** KEITH A. MOSS M.D. (PRESIDENT)
- **Authorized official phone:** (815) 935-2784

## Contact information

- **Practice address:** 300 RIVERSIDE DR, SUITE 2400, BOURBONNAIS, IL 60914-4996
- **Practice address phone:** (815) 935-2784
- **Practice address fax:** (815) 935-5687
- **Mailing address:** 300 RIVERSIDE DR, SUITE 2400, BOURBONNAIS, IL 60914-4996
- **Mailing address phone:** (815) 935-2784
- **Mailing address fax:** (815) 935-5687

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 036105851 | IL | Yes |

## Other

- **Enumeration date:** 07/11/2007
- **Last updated:** 05/28/2008