Provider Demographics
NPI:1053523704
Name:MOORE, APRIL (MD)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-0268
Mailing Address - Country:US
Mailing Address - Phone:815-599-7950
Mailing Address - Fax:
Practice Address - Street 1:803 S FIRST AVE
Practice Address - Street 2:
Practice Address - City:FORRESTON
Practice Address - State:IL
Practice Address - Zip Code:61030-9575
Practice Address - Country:US
Practice Address - Phone:815-938-3130
Practice Address - Fax:815-938-3352
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036120895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL306120895Medicaid
IL306120895Medicaid