Organization
DAVID MOORE, D.O., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID M MOORE D.O. (PRESIDENT)
(773) 327-3238
Entity
Organization
Contact information
Practice address
3000 N HALSTED ST STE 506, CHICAGO, IL 60657-5194
(773) 327-3238
(773) 327-3058
Mailing address
3000 N HALSTED ST STE 506, CHICAGO, IL 60657-5194
(773) 327-3238
(773) 327-3058
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01622212
BLUE SHIELD PROVIDER #
IL
Enumeration date
09/20/2006
Last updated
08/22/2020
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