Individual
TIMOTHY MORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 W COURT ST, KANKAKEE, IL 60901-3661
(815) 937-2100
Mailing address
555 W COURT ST, SUITE 410, KANKAKEE, IL 60901-3664
(888) 828-3193
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-076975
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036076975
—
IL
01
—
4622394
BLUE CROSS
—
Enumeration date
12/21/2007
Last updated
03/27/2009
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