Provider Demographics
NPI:1902880354
Name:MORAN, MICHELLE THERESA (MD)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:THERESA
Last Name:MORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:213 N HURSTBOURNE PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5139
Practice Address - Country:US
Practice Address - Phone:502-327-5135
Practice Address - Fax:502-327-9475
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000545891OtherANTHEM
KY004163OtherSIHO
KY000023029SOtherHUMANA- NORTON
KY7100031130Medicaid
KY9340096OtherCIGNA- NORTON
IN200909270OtherMEDICAID IN- NORTON CMA
KY50018435OtherPASSPORT- NORTON CMA
KY3500224000OtherPASSPORT ADVANTAGE- NORTON CMA- HURSTBOURNE
1902880354OtherNPI
KY200909270OtherMD WISE- NORTON CMA
KY50018435OtherPASSPORT- NORTON CMA
KY000000545891OtherANTHEM