Individual
JUSTIN RICHARDSON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1901 W HARRISON ST, CHICAGO, IL 60612-3714
(312) 864-6000
Mailing address
1901 W HARRISON ST, CHICAGO, IL 60612-3714
(312) 864-6000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125.085396
IL
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/10/2024
Last updated
05/11/2025
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