Provider Demographics
NPI:1407640147
Name:MOORE, GRIFFIN (DO)
Entity type:Individual
Prefix:
First Name:GRIFFIN
Middle Name:
Last Name:MOORE
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 W 95TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3072
Mailing Address - Country:US
Mailing Address - Phone:708-398-0287
Mailing Address - Fax:
Practice Address - Street 1:4220 W 95TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3072
Practice Address - Country:US
Practice Address - Phone:708-398-0287
Practice Address - Fax:708-684-0281
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program