Individual
MICHAEL J MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
988102 NEBRASKA MEDICAL CENTER, OMAHA, NE 68198-8102
(402) 559-9800
(402) 559-7929
Mailing address
988102 NEBRASKA MEDICAL CENTER, OMAHA, NE 68198-8102
(402) 559-9800
(402) 559-7929
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
34904
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026059800
—
NE
05
—
124508
—
AZ
01
—
P00439640
RAILROAD MEDICARE
AZ
Enumeration date
08/13/2006
Last updated
10/09/2012
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