Individual
DR. TERRENCE C MOISAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12255 S 80TH AVE, PALOS HEIGHTS, IL 60463-1270
(708) 448-1400
Mailing address
10660 W 143RD ST STE B, ORLAND PARK, IL 60462-1989
(708) 349-0055
(708) 460-8031
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036050798
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036050798
MEDICAID
IL
01
—
290007170
PALMETTO RR MEDICARE
IL
Enumeration date
05/27/2006
Last updated
05/18/2008
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