Individual
DONALD MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPSS
Contact information
Practice address
2925 RUSSELL ST, DETROIT, MI 48207-4825
(248) 814-3004
Mailing address
707 W MILWAUKEE ST, DETROIT, MI 48202-2943
(313) 344-9099
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
MI
Other
Enumeration date
04/14/2023
Last updated
04/14/2023
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