| Michael S Moore, MD | |
|
112 E 5th Ave, Antigo, WI 54409-2710 | |
| (715) 623-2331 | |
| Not Available |
| Full Name | Michael S Moore |
|---|---|
| Gender | Male |
| Speciality | Emergency Medicine |
| Location | 112 E 5th Ave, Antigo, Wisconsin |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720143084 | NPI | - | NPPES |
| 34046400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207P00000X | Emergency Medicine | 41388 (Wisconsin) | Primary |
| Entity Name | Integritas Emergency Physician Services Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1790128817 PECOS PAC ID: 7113167446 Enrollment ID: O20130710000760 |
| Entity Name | Statera Health Care Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1043874449 PECOS PAC ID: 0244565729 Enrollment ID: O20190708000284 |
| Mailing Address | Practice Location Address |
|---|---|
| Michael S Moore, MD 112 E 5th Ave, Antigo, WI 54409-2710 Ph: (715) 623-2331 | Michael S Moore, MD 112 E 5th Ave, Antigo, WI 54409-2710 Ph: (715) 623-2331 |
Stephen Hubbard, MD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 112 E 5th Ave, Antigo, WI 54409 Phone: 715-623-2351 | |
Dr. Marc D Biedermann, M.D. Emergency Medicine Medicare: Medicare Enrolled Practice Location: 112 E 5th Ave, Antigo, WI 54409 Phone: 715-623-2331 |