Individual
DR. MICHAEL D MOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1875 DEMPSTER ST, SUITE 665, PARK RIDGE, IL 60068
(847) 825-1590
(847) 825-1604
Mailing address
1875 DEMPSTER ST, SUITE 665, PARK RIDGE, IL 60068-1186
(847) 825-1590
(847) 825-1604
Taxonomy
Speciality
Code
Description
License number
State
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
036-083401
IL
207VG0400X
Gynecology Physician
036083401
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036083401
—
IL
Enumeration date
10/24/2005
Last updated
08/08/2018
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