Individual
MEGAN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1611 W HARRISON ST STE 400, CHICAGO, IL 60612-4861
(877) 632-6637
(708) 409-5179
Mailing address
1611 W HARRISON ST STE 400, CHICAGO, IL 60612-4861
(877) 632-6637
(708) 409-5179
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085009405
IL
363A00000X
Physician Assistant
10003889A
IN
363A00000X
Physician Assistant
7205-23
WI
363A00000X
Physician Assistant
—
—
Other
Enumeration date
11/28/2022
Last updated
01/09/2023
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