Individual
DR. JACOB LAYNE MOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
32255 NORTHWESTERN HWY STE 214, FARMINGTON HILLS, MI 48334
(248) 855-5620
(248) 855-5628
Mailing address
29992 NORTHWESTERN HWY STE C, FARMINGTON HILLS, MI 48334-3292
(248) 851-1430
(248) 851-5319
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5101019711
MI
207R00000X
Internal Medicine Physician
5315054293
MI
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
5101019711
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043574478
—
MI
01
—
MI4989641
MEDICARE PTAN
MI
Enumeration date
06/29/2012
Last updated
12/06/2019
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