Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301083833 | MI |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 4301083833 | MI |
NPI | 1437374931 |
---|---|
Provider Name | Andrew Moore |
First Address | Ann Arbor, MI 48106 |
Second Address | Chelsea, MI 48118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 02/08/2021 |