Organization
ILLINOIS UROGYNECOLOGY, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MOEN MD (PRES)
(847) 825-1590
Entity
Organization
Contact information
Practice address
1875 DEMPSTER ST, SUITE 665, PARK RIDGE, IL 60068-1186
(847) 825-1590
(847) 825-1604
Mailing address
1875 DEMPSTER ST, SUITE 665, PARK RIDGE, IL 60068-1186
(847) 825-1590
(847) 825-1604
Taxonomy
Speciality
Code
Description
License number
State
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
—
IL
207VG0400X
Gynecology Physician
—
IL
Other
Enumeration date
08/08/2006
Last updated
08/09/2018
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