1134563869 NPI number — EMMA BAKER MOSS M.D.

Table of content: EMMA BAKER MOSS M.D. (NPI 1134563869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134563869 NPI number — EMMA BAKER MOSS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSS
Provider First Name:
EMMA
Provider Middle Name:
BAKER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOSS
Provider Other First Name:
MATTHEW
Provider Other Middle Name:
BAKER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134563869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 W MICHIGAN ST APT 1114
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53203-2821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-459-0605
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MILWAUKEE RADIOLOGISTS, LTD.
Provider Second Line Business Practice Location Address:
6150 W. LAYTON AVE
Provider Business Practice Location Address City Name:
GREENFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-914-9430
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 73851-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)