Individual
MICHAEL S MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
112 E 5TH AVE, ANTIGO, WI 54409-2710
(715) 623-2331
Mailing address
112 E 5TH AVE, ANTIGO, WI 54409-2710
(715) 623-2331
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
41388
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34046400
—
WI
Enumeration date
12/27/2006
Last updated
07/08/2007
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