DR. NICHOLAS M MOORE (NPI# 1073017679) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073017679 |
| Entity Type | Individual |
| Full Name | DR. NICHOLAS M MOORE |
| Credential | PHD |
| Practice Address |
1653 W Congress Pkwy Ste 1173 Chicago IL 60612-3833 |
| Practice Telephone | 3129423214 |
| Practice Fax Number | 3129426787 |
| Mailing Telephone | 3129423214 |
| Mailing Fax Number | 3129426787 |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2018-03-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 246QM0706X |
Spec/Tech, Pathology Specialization: Medical Technologist |
Technologists, Technicians & Other Technical Service Providers | ||
| Y | 247ZC0005X |
Pathology Specialization: Clinical Laboratory Director, Non-physician |
Technologists, Technicians & Other Technical Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265042691 | Nicholas Antonio Moore | Pharmacist | 604 Cherry Dr, Fairview Heights, IL 62208-2846 | 2020-07-31 |
| 1265727556 | Nicholas Jay Moore | Family Medicine | 26850 Providence Pkwy Ste 260, Novi, MI 48374-1256 | 2011-06-14 |
| 1417905092 | Nicholas J.e. Moore | Radiology | 1390 Kelly Johnson Blvd, Colorado Springs, CO 80920-3908 | 2006-05-05 |
| 1093339491 | Nicholas Simms Moore | Student in an Organized Health Care Education/Training Program | 330 Brookline Ave, Boston, MA 02215-5491 | 2020-06-01 |
| 1396372868 | Nicholas Lawrence Moore | Student in an Organized Health Care Education/Training Program | 111 Colchester Ave, Burlington, VT 05401-1473 | 2020-03-25 |
| 1013550383 | Nicholas Moore | Nurse Anesthetist, Certified Registered | 9333 Imperial Hwy, Downey, CA 90242-2812 | 2019-10-19 |
| 1336795509 | Nicholas M Moore | Psychologist | 1848 Se 1st Ave, Fort Lauderdale, FL 33316-2875 | 2019-08-14 |
| 1225695703 | Nicholas Jay Moore | Dentist | 440 E Tampa St, Springfield, MO 65806-1131 | 2019-05-21 |
| 1467017343 | Nicholas Maximilian Moore | Student in an Organized Health Care Education/Training Program | 1250 E Marshall St, Richmond, VA 23298-5051 | 2019-05-06 |
| 1811421258 | Nicholas Moore | Student in an Organized Health Care Education/Training Program | 9333 Park West Blvd, Suite 102, Knoxville, TN 37923-4341 | 2017-04-12 |
| Street Address |
1653 W CONGRESS PKWY STE 1173 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60612-3833 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144839739 | Sandhya Shri Kannayiram | Internal Medicine | 1901w Harrison Street, Chicago, IL 60612 | 2020-07-29 |
| 1568080174 | Nastaran Ordoyo Haghani Rad | Student in an Organized Health Care Education/Training Program | 1950 W. Polk Street, Room 6203, Chicago, IL 60612 | 2020-07-09 |
| 1669090403 | Marianne Gagnon-konamna | Student in an Organized Health Care Education/Training Program | 1950 West Polk Street, Chicago, IL 60612 | 2020-07-08 |
| 1922625672 | Tanya Montgomery Nee Brown | Pediatrics | 1950 West Polk Street, Neonatal and Perinatal Department, Chicago, IL 60612 | 2020-06-29 |
| 1124643028 | Ashley Swan | Dentist | 801 S. Paulina St, Uic College of Dentistry - Endodontics Clinic, Chicago, IL 60612 | 2020-06-16 |
| 1831711381 | Baillie Anne Bronner | Obstetrics & Gynecology | 1653 W Congress Pkwy Chicago, Il 60612, Chicago, IL 60612 | 2020-05-07 |
| 1154942449 | Keisha Davell Cole | Case Manager/Care Coordinator | 612 S Western Ave Unit 1, Chicago, IL 60612 | 2020-04-28 |
| 1275153777 | Isac Lim | Student in an Organized Health Care Education/Training Program | 1234 S. Wells, Chicago, IL 60612 | 2020-04-24 |
| 1578183414 | Zachary Belden | Student in an Organized Health Care Education/Training Program | Uic Psychiatry Residency 912 S. Wood St., Rm 130b Npi-s (mc 913), Chicago, IL 60612 | 2020-04-21 |
| 1548880560 | Christina Nunez | Student in an Organized Health Care Education/Training Program | 801 S. Paulina Street, M/c 850, Chicago, IL 60612 | 2020-04-20 |
| Find all providers in zip 60612 | ||||
| Taxonomy Code | 247ZC0005X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Pathology |
| Specialization | Clinical Laboratory Director, Non-physician |
| An individual who is state-licensed as a clinical laboratory director and meets the qualifications in the Clinical Laboratory Improvement Amendments of 1988 for non-physicians (non-MD/DO) as defined in the CFR 42 Part 493.1405. |
| Notes: Source: National Uniform Claim Committee [1/1/2007: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629575972 | Madina Sukhanova | Pathology | 910 S Michigan Ave Apt 1513, Chicago, IL 60605-2288 | 2018-04-11 |
| 1740687482 | Deanna Franke | Pathology | 75 Remittance Dr, Dept 6601, Chicago, IL 60675-6601 | 2014-11-24 |
| 1972946812 | Chao Qi | Pathology | 303 E Chicago Ave, Department of Pathology, Chicago, IL 60611-4296 | 2013-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912193079 | Carol Ann Nufer | Pathology | 7211 Jackson Blvd, #2, Forest Park, IL 60130-3247 | 2007-09-21 |
| 1952940488 | Syed Haque | Pathology | 350 S Northwest Hwy Ste 300, Park Ridge, IL 60068-4262 | 2020-01-01 |
| 1578040101 | Sivakumar Ramu | Pathology | 603 Country Club Dr, Bensenville, IL 60106-1329 | 2018-07-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.