Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 036-07059 | IL |
NPI | 1194725291 |
---|---|
Provider Name | James M Moss |
First Address | Elk Grove Village, IL 60007-3361 |
Second Address | Elk Grove Village, IL 60007-3361 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 06/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036070259 | (05) | IL |
1617373 | BCBS OF IL (01) | IL |
E43581 | (02) |