Individual
DR. KEITH A MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 RIVERSIDE DR STE 2100, BOURBONNAIS, IL 60914-5004
(815) 935-2784
(815) 935-5687
Mailing address
400 RIVERSIDE DR STE 2100, BOURBONNAIS, IL 60914-5004
(815) 935-2784
(815) 935-5687
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036105851
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0361058512
—
IL
Enumeration date
06/02/2006
Last updated
10/25/2022
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