Provider Demographics
NPI:1316072366
Name:MORIARITY, JAMES MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:MORIARITY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:16169 WATERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8394
Mailing Address - Country:US
Mailing Address - Phone:574-532-0304
Mailing Address - Fax:574-631-1599
Practice Address - Street 1:1842 MOREAU DRIVE
Practice Address - Street 2:
Practice Address - City:NOTRE DAME
Practice Address - State:IN
Practice Address - Zip Code:46556
Practice Address - Country:US
Practice Address - Phone:574-631-5471
Practice Address - Fax:574-631-1599
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01036239B204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine