Individual
MICHELLE K MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4179 WESTBROOK DR, CLEVELAND, OH 44144-1234
(216) 406-8979
Mailing address
4179 WESTBROOK DR, CLEVELAND, OH 44144-1234
(216) 406-8979
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SL601708
—
OH
Enumeration date
02/24/2020
Last updated
02/24/2020
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