Individual
JONATHAN MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
180 HARVESTER DR STE 110, BURR RIDGE, IL 60527-6686
(773) 834-4064
Mailing address
5841 S MARYLAND AVE # MC1099, CHICAGO, IL 60637-1447
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036070793
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036070793
—
IL
Enumeration date
12/27/2006
Last updated
04/13/2015
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