Provider Demographics
NPI:1871564948
Name:MORAN, MICHAEL DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:MORAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:30131 TOWN CENTER DR STE 211
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2088
Mailing Address - Country:US
Mailing Address - Phone:949-297-8167
Mailing Address - Fax:949-297-8350
Practice Address - Street 1:30131 TOWN CENTER DR STE 211
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2088
Practice Address - Country:US
Practice Address - Phone:949-297-8167
Practice Address - Fax:949-297-8350
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA62602207RC0000X
CAA062602207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE51170Medicare UPIN