Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 48519 | WI |
N | 111NI0900X | Internist | 48519 | WI |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 48519-21 | WI |
NPI | 1023064508 |
---|---|
Provider Name | Alvia Moid |
First Address | North Chicago, IL 60064-3048 |
Second Address | North Chicago, IL 60064-3048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 20/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43526700 | (05) | WI |