Provider Demographics
NPI:1154411056
Name:DAVID D MORAN MD LTD
Entity type:Organization
Organization Name:DAVID D MORAN MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DUFFY
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-823-2129
Mailing Address - Street 1:42 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4054
Mailing Address - Country:US
Mailing Address - Phone:847-823-2129
Mailing Address - Fax:847-823-1639
Practice Address - Street 1:42 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4054
Practice Address - Country:US
Practice Address - Phone:847-823-2129
Practice Address - Fax:847-823-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03638570207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILAM5338276OtherDEA
D12211Medicare UPIN
ILAM5338276OtherDEA