NPI 1275902132
Otha Moore
Practice location
- Address
- 18430 Westhampton, Southfield, MI 48075
- Phone
- (313) 844-1496
- Mailing address
- 18430 Westhampton Ave, Southfield, MI 48075-4116
Registered specialties
Exclusive Provider Organization
Primary
Registry record
- NPI
- 1275902132
- Entity type
- Individual
- Sex (as registered)
- Male
- NPI issued
- 22 Sep 2015
- Record last updated
- 22 Sep 2015
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.