Individual
DR. CHARLES MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1535 GULL RD, MSB 015, KALAMAZOO, MI 49048-1650
(269) 226-6933
(269) 226-6949
Mailing address
1535 GULL RD, MSB 015, KALAMAZOO, MI 49048-1650
(269) 226-6933
(269) 226-6949
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301038198
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CM038198
BLUE CROSS BLUE SHIELD
MI
01
—
G56008127
MEDICARE - THREE RIVERS
MI
Enumeration date
05/16/2006
Last updated
03/04/2008
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