Individual
CAMILLE MCCORMICK MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1255 S STATE ST UNIT 1001, CHICAGO, IL 60605-3454
(650) 814-1114
Mailing address
1255 S STATE ST UNIT 1001, CHICAGO, IL 60605-3454
(650) 814-1114
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036.129798
IL
207R00000X
Internal Medicine Physician
125054430
IL
Other
Enumeration date
07/08/2008
Last updated
09/07/2012
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