Individual
MICHELE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
7575 NORTHCLIFF AVE, SUITE 305, BROOKLYN, OH 44144-3267
(216) 398-5535
(216) 749-3366
Mailing address
31249 WALKER RD, BAY VILLAGE, OH 44140-1409
(440) 250-0635
(440) 250-0635
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34006836M
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
215841
—
OH
01
—
385235
ANTHEM PIN NUMBER
OH
01
—
7051201
AETNA PROVIDER NUMBER
OH
05
—
743136652027
—
OH
Enumeration date
09/01/2006
Last updated
07/09/2007
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