Earl G Moehn M D P C

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

4301025603 Issued in MI

Legal business name

EARL G MOEHN M D P C

Practice address

100 Belleview St
Mount Clemens, MI 48043-2241

Phone

(586) 463-4204

Fax

(586) 268-0953

NPI assigned

Aug 5, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Earl G Moehn, M.D.

Title

Physician

Phone

(586) 463-4204

Specialties & licenses 1

Addresses

Other identifiers 4

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477562882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BELLEVIEW ST",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432241",
            "telephone_number": "586-463-4204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BELLEVIEW ST",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480432241",
            "telephone_number": "586-463-4204",
            "fax_number": "586-268-0953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EARL G MOEHN M D P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOEHN",
        "authorized_official_first_name": "EARL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "586-463-4204",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301025603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "4301025603",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P00070675",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720810",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MI",
            "identifier": "4301025603",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Stacia Dzikunu, D.O.
• Sydney Morgan Edinger, MD
• Eds Associates
• Emily W. Edwards, LLMSW
• Raquel Latrice Edwards, LLMSW, CAADC-DP
• Mary Anne Eineichner, APRN

• Surgery Physician in Mount Clemens, MI
• Providers in Mount Clemens, MI by specialty
• Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.