Individual
DR. NICHOLAS M MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1653 W CONGRESS PKWY STE 1173, CHICAGO, IL 60612-3833
(312) 942-3214
(312) 942-6787
Mailing address
1653 W CONGRESS PKWY STE 1173, CHICAGO, IL 60612-3833
(312) 942-3214
(312) 942-6787
Taxonomy
Speciality
Code
Description
License number
State
246QM0706X
Medical Technologist
—
—
247ZC0005X
Clinical Laboratory Director (Non-physician)
Primary
—
—
Other
Enumeration date
03/20/2018
Last updated
03/20/2018
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