Individual
JULIE A MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
501 W NORTH AVE STE 103, MELROSE PARK, IL 60160-1603
(708) 450-5086
Mailing address
501 W NORTH AVE STE 103, MELROSE PARK, IL 60160-1603
(708) 450-5086
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036075509
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036075509
—
IL
Enumeration date
04/03/2006
Last updated
02/17/2021
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