Moore, Renata Charissa
Moore, Renata Charissa is an individual health care provider with primary practice located at 1990 E Lake Shore Dr , Decatur IL 62521-3811. She recently has only one registered license in Allopathic & Osteopathic Physicians / Radiation Oncology, which is considered as her primary health care specialty. Moore, Renata Charissa can be contacted via phone (217) 464-2900.Contact Information
Primary practice address
1990 E Lake Shore Dr
Decatur IL 62521-3811
Phone: (217) 464-2900
Fax: (217) 464-2909
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Radiation Oncology | 2085R0001X | 036093129 | Illinois |
Profile Details
| NPI number | 1851483572 |
|---|---|
| LBN Legal business name | Moore, Renata Charissa |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 29th, 2006 |
| Last updated | Feb 12th, 2014 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1851483572 | NPPES |
| Illinois | MEDICAID | 036093129 |
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