Individual
ELLEN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3912 32ND AVE, HUDSONVILLE, MI 49426-8460
(616) 252-8700
(616) 252-8750
Mailing address
3912 32ND AVE, HUDSONVILLE, MI 49426-8460
(616) 252-8700
(616) 252-8750
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301115010
MI
207Q00000X
Family Medicine Physician
Primary
4351027347
MI
Other
Enumeration date
06/18/2018
Last updated
08/25/2021
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