Provider Demographics
NPI:1962847319
Name:MOORE, MALIA JANE (MD)
Entity type:Individual
Prefix:DR
First Name:MALIA
Middle Name:JANE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:250 N SHADELAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-962-3734
Mailing Address - Fax:
Practice Address - Street 1:720 ESKENAZI AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5187
Practice Address - Country:US
Practice Address - Phone:317-880-3900
Practice Address - Fax:254-286-7055
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2021-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01075154A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine