Mr. Otha Moore
Mr. Otha Moore is an Exclusive Provider Organization in Southfield, Michigan. Practices as a sole proprietor. Licensed in Michigan.
- Licensed in
- MI
- In the registry since
- 2015
Practice location Address checks out
18430 WesthamptonSouthfield, MI 48075
Phone: (313) 844-1496
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Specialties & licences
| Exclusive Provider Organization (primary) | Taxonomy 302F00000X · Licence 7153185 (MI) |
|---|
Record details
| NPI number | 1275902132 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | September 22, 2015 |
| Last updated in NPPES | September 22, 2015 |
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