Individual
DR. KENNETH LAWRENCE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12 TARTAN RIDGE RD, BURR RIDGE, IL 60527-8904
(630) 323-1316
Mailing address
12 TARTAN RIDGE ROAD, BURR RIDGE, IL 60527-8904
(630) 323-1316
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
036-053328
IL
Other
Enumeration date
09/07/2006
Last updated
01/20/2016
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