Organization
ENVIRONMENTAL & RESPIRATORY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRENCE MOISAN M.D. (PRESIDENT)
(708) 349-0055
Entity
Organization
Contact information
Practice address
12250 S 80TH AVE, PALOS HEIGHTS, IL 60463
(708) 448-1400
Mailing address
10660 W 143RD ST STE B, ORLAND PARK, IL 60462-1989
(708) 349-0055
(708) 460-8031
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1617513
BLUE CROSS BLUE SHIELD
IL
01
—
CB9988
PALMETTO RR MEDICARE
IL
Enumeration date
08/22/2006
Last updated
07/21/2022
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