Provider Demographics
NPI:1366538274
Name:WILLIAM A MORAN MD LLC
Entity type:Organization
Organization Name:WILLIAM A MORAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-394-4930
Mailing Address - Street 1:605 W CENTRAL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2377
Mailing Address - Country:US
Mailing Address - Phone:847-394-4930
Mailing Address - Fax:847-394-8505
Practice Address - Street 1:605 W CENTRAL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2377
Practice Address - Country:US
Practice Address - Phone:847-394-4930
Practice Address - Fax:847-394-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106016207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106016Medicaid
IL01633940OtherBCBS OF IL
IL01633940OtherBCBS OF IL
IL208287Medicare ID - Type Unspecified