Individual
MR. MICHAEL ALLEN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4200 DIVISION AVE N, COMSTOCK PARK, MI 49321-9546
(616) 252-1600
(616) 252-1666
Mailing address
1925 BRETON RD SE, SUITE 201, GRAND RAPIDS, MI 49506-4810
(616) 252-1600
(616) 252-1666
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601002580
MI
Other
Enumeration date
08/04/2005
Last updated
05/09/2012
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