Samiraly Moosa, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036153598 Issued in IL

Practice address

1044 N. Francisco Avenue Attn. Gme Office
Chicago, IL 60622

Phone

(773) 360-6346

Fax

(773) 292-5954

NPI assigned

May 4, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1525392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1699264622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1044 N. FRANCISCO AVE",
            "address_2": "SUITE 100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60622",
            "telephone_number": "773-292-8200",
            "fax_number": "773-278-3889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1044 N. FRANCISCO AVENUE ATTN. GME OFFICE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60622",
            "telephone_number": "773-360-6346",
            "fax_number": "773-292-5954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOOSA",
        "first_name": "SAMIRALY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-04",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036153598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vivian Marie Moore, LCPC
• Tamera Patrice Moorer
• Tanyia Moorer
• Jona Moorghen
• Elizabeth Ann Moorhouse, MSW, LCSW, PMH-C
• Mufadal Ammar Moosabhoy, M.D.
• Emily Moquin, MSW
• Guido Mora Calderon, MD
• Stephanie Mora Hernandez
• Andrea Mora

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; 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.