Provider Demographics
NPI:1184885378
Name:MOORE, MICHAEL SEAN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SEAN
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8180 BELDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-2645
Mailing Address - Country:US
Mailing Address - Phone:651-282-4283
Mailing Address - Fax:
Practice Address - Street 1:GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:4430 MISSOURI AVENUE
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-9098
Practice Address - Country:US
Practice Address - Phone:573-596-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN53953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine