Individual provider · Type 1 NPI
Nicholas M. Moore, PhD
Clinical Laboratory Director (Non-physician) · Chicago, IL
NPI number
1073017679
Active
Practice location
1653 W Congress Pkwy Ste 1173
Chicago, IL 60612-3833
Fax (312) 942-6787
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Technologist | 246QM0706X | None listed |
| Clinical Laboratory Director (Non-physician) Primary | 247ZC0005X | None listed |
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.
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About NPI 1073017679
Nicholas M. Moore, PhD's National Provider Identifier is 1073017679, issued on Mar 20, 2018. The primary taxonomy on file is Clinical Laboratory Director (Non-physician) (247ZC0005X), and the practice location is in Chicago, IL. The record was last updated on Mar 20, 2018.