Basic Information
| Provider Information | |||||||||
| NPI: | 1356832273 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOELLER | ||||||||
| FirstName: | DARCIE | ||||||||
| MiddleName: | DENISE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7556 JACKSON BLVD | ||||||||
| Address2: | |||||||||
| City: | FOREST PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601301854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088368600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2020 W HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606123741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125724500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2018 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0500X | 036-156409 | IL | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Preventive Medicine/Occupational Environmental Medicine | 207Q00000X | 036156409 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.