Individual
ANDREW MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3333 GREEN BAY RD, NORTH CHICAGO, IL 60064-3037
(360) 930-2912
Mailing address
3333 GREEN BAY RD, NORTH CHICAGO, IL 60064-3037
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/06/2020
Last updated
05/06/2020
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