Organization
EARL G MOEHN M D P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EARL G MOEHN M.D. (PHYSICIAN)
(586) 463-4204
Entity
Organization
Contact information
Practice address
100 BELLEVIEW ST, MOUNT CLEMENS, MI 48043-2241
(586) 463-4204
(586) 268-0953
Mailing address
100 BELLEVIEW ST, MOUNT CLEMENS, MI 48043-2241
(586) 463-4204
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301025603
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720810
—
MI
01
—
4301025603
LICENSE
MI
01
—
4301025603
BLUE CROSS BLUE SHIELD MI
—
01
—
P00070675
RAIL ROAD MEDICARE
—
Enumeration date
08/05/2006
Last updated
08/22/2020
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