Organization · NPI-2

Keith A. Moss, M.D., Sc

Internal Medicine · Bourbonnais, IL

NPI number1154520112
StatusActive
Last updated in NPPESMay 28, 2008

Details

NPI
1154520112
Entity type
Organization (NPI-2)
Legal business name
Keith A. Moss, M.D., Sc
Organization subpart
No
Enumeration date
Jul 11, 2007
Last updated
May 28, 2008

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine036105851ILYes

Practice location

300 Riverside Dr
Suite 2400
Bourbonnais, IL 60914-4996

Phone 815-935-2784 · Fax 815-935-5687

Mailing address

300 Riverside Dr
Suite 2400
Bourbonnais, IL 60914-4996

Phone 815-935-2784 · Fax 815-935-5687

Authorized official

Keith A. Moss
President
8159352784

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