DR. KENNETH LAWRENCE MOORE (NPI# 1891899258) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891899258 |
| Entity Type | Individual |
| Full Name | DR. KENNETH LAWRENCE MOORE |
| Credential | M.D. |
| Practice Address |
12 Tartan Ridge Rd Burr Ridge IL 60527-8904 |
| Mailing Address |
12 Tartan Ridge Road Burr Ridge IL 60527-8904 |
| Practice Telephone | 6303231316 |
| Mailing Telephone | 6303231316 |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2016-01-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
036-053328 | IL | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134490766 | Kenneth Moore | Skilled Nursing Facility | 751 Orange Ave, Saint Cloud, FL 34769-3063 | 2012-01-12 |
| 1376722348 | Kenneth Jerald Moore | Social Worker | 6906 S Utica Pl, Tulsa, OK 74136-5158 | 2007-10-26 |
| 1669409967 | Kenneth Earl Moore | Specialist/Technologist | 901 Lincoln Rd, Idabel, OK 74745-7802 | 2006-06-26 |
| 1326096470 | Kenneth Edward Moore | Physical Medicine & Rehabilitation | Mcguire Vamc, 1201 Broad Rock Rd, Richmond, VA 23249 | 2006-05-04 |
| 1013995323 | Kenneth Levi Moore IIi | Nurse Practitioner | 5981 Far Hills Ave, Dayton, OH 45429-2211 | 2006-01-06 |
| 1245889021 | Kenneth Moore | Dentist | 611 S George Nigh Expy, Mcalester, OK 74501-7277 | 2019-09-05 |
| 1144796103 | Kenneth Moore | Behavior Technician | 41521 W 11 Mile Rd, Novi, MI 48375-1803 | 2018-10-17 |
| 1568963627 | Kenneth Sheppard Moore | Military Health Care Provider | 34800 Bob Wilson Dr, San Diego, CA 92134-1098 | 2018-02-23 |
| 1710358445 | Kenneth Steven Moore | Psychologist | 100 Ledgehill Rd, Bennington, VT 05201-2273 | 2015-10-07 |
| 1013304054 | Kenneth Adam Moore | Student in an Organized Health Care Education/Training Program | 910 Madison Ave, Suite 1031, Memphis, TN 38103-3403 | 2015-04-16 |
| Street Address |
12 TARTAN RIDGE RD |
| City | BURR RIDGE |
| State | IL |
| Zip Code | 60527-8904 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023635364 | Crystal Mary Dirks | Occupational Therapy Assistant | 211 75th St, Burr Ridge, IL 60527 | 2020-07-02 |
| 1386276350 | Valerie Moreno-tucker | Counselor | 277 83rd St, Burr Ridge, Il 60527, Burr Ridge, IL 60527 | 2020-02-07 |
| 1831734763 | Annette Maria Zajac | Occupational Therapist | 16 91st St., Burr Ridge, IL 60527 | 2019-11-14 |
| 1568023109 | Jennifer Rogers | Counselor | 277 83rd St., Ste. D, Burr Ridge, IL 60527 | 2019-06-25 |
| 1710458526 | Dima Sibai Dds PC | Clinic/Center | 940 Plianfield Rd., Willowbrook, IL 60527 | 2018-12-06 |
| 1558850495 | Jeanie C. Lucy PC | Optometrist | 6340 Americana Drive Suite 1108, Willowbrook, IL 60527 | 2018-05-07 |
| 1538664032 | Athletico,ltd | Physical Therapist | 6860 N Frontage Rd Ste B, Burr Ridge, IL 60527 | 2018-03-27 |
| 1003314832 | Ams Wellness Pllc | Psychologist | 277 83rd St Ste D, Burr Ridge, IL 60527 | 2018-01-26 |
| 1023564671 | Natasa Manasovska | Dentist | 6111 Knollwood Rd, Apt. 103, Willowbrook, IL 60527 | 2016-09-01 |
| 1669927893 | Marie Ann Korallus | Nurse Practitioner | 7055 High Grove, Burr Ridge, IL 60527 | 2016-08-17 |
| Find all providers in zip 60527 | ||||
| Taxonomy Code | 2084A0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Medicine |
| A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |
| Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144741844 | Rose Medical Association, Inc. | Psychiatry & Neurology | 209 W Romeo B Garrett Ave, Peoria, IL 61605-2502 | 2017-07-03 |
| 1215208491 | Fred M Levin Md Sc | Psychiatry & Neurology | 111 N. Wabash Avenue, Suite 1022, Chicago, IL 60602-1903 | 2012-01-20 |
| 1568525277 | Usha D Malkerneker | Psychiatry & Neurology | 17100 Dixie Hwy Ste D, Hazel Crest, IL 60429-1485 | 2006-12-18 |
| 1508979758 | Charles R Harris | Psychiatry & Neurology | 12230 Cashlenan Ln, New Lenox, IL 60451-2799 | 2006-08-15 |
| 1255340097 | Michael Rachman | Psychiatry & Neurology | 1375 E Schaumburg Road, Suite 260, Schaumburg, IL 60194-3658 | 2006-08-07 |
| 1245217959 | Raymond Christopher Garcia | Psychiatry & Neurology | 8616 Northern Ave, Rockford, IL 61107-5309 | 2005-12-23 |
| 1184610107 | Lucy Ibrahim | Psychiatry & Neurology | 1280 Windham Pkwy, Romeoville, IL 60446-1673 | 2005-09-26 |
| 1528681764 | Holon Inclusive Behavioral Health | Psychiatry & Neurology | 301 S Main St, Dupo, IL 62239-1325 | 2020-05-21 |
| 1013555416 | Mathers Recovery LLC | Psychiatry & Neurology | 81 E Grand Ave, Fox Lake, IL 60020-1557 | 2019-12-16 |
| 1083252480 | Mathers Recovery LLC | Psychiatry & Neurology | 585 Tollgate Rd, Elgin, IL 60123-9323 | 2019-12-16 |
| Find all providers with the same taxonomy | ||||
| City | BURR RIDGE |
| Zip Code | 60527 |
Please comment or provide details below to improve the information on DR. KENNETH LAWRENCE MOORE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.