Individual
NICHOLAS JAY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
26850 PROVIDENCE PKWY STE 260, NOVI, MI 48374-1256
(248) 465-5140
(248) 465-5141
Mailing address
26850 PROVIDENCE PKWY STE 260, NOVI, MI 48374-1256
(248) 465-5140
(248) 465-5141
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301108292
MI
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
4301108292
MI
Other
Enumeration date
06/14/2011
Last updated
04/16/2019
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