Individual
MARY ELLEN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4301 W 95TH ST STE 1, OAK LAWN, IL 60453-2698
(708) 425-5500
(708) 425-0771
Mailing address
4140 SOUTHWEST HWY, HOMETOWN, IL 60456-1135
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
125.061971
IL
Other
Enumeration date
07/15/2012
Last updated
12/28/2021
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