Individual
DR. DONALD R MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
25599 KELLY RD, SUITE B, ROSEVILLE, MI 48066-4975
(586) 445-2330
(586) 445-2352
Mailing address
130 TOWN CENTER DR, STE 203, TROY, MI 48084-1744
(586) 445-2330
(586) 445-2352
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DM038055
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110131072
RAILROAD MEDICARE
—
01
—
1105016431
BLUE CROSS BLUE SHIELD
MI
05
—
3232662
—
MI
01
—
DM038055
STATE LICENSE
MI
Enumeration date
07/12/2006
Last updated
10/22/2020
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