Provider Demographics
NPI:1164477246
Name:SIMPSON, MINDY L (MD)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:L
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:L
Other - Last Name:GRUNZKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1653 W CONGRESS PKWY
Mailing Address - Street 2:1591 JELKE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3833
Mailing Address - Country:US
Mailing Address - Phone:312-942-8114
Mailing Address - Fax:312-942-8975
Practice Address - Street 1:1653 W CONGRESS PKWY
Practice Address - Street 2:1591 JELKE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:312-942-8114
Practice Address - Fax:312-942-8975
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-114998208000000X
CO45736208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1992758544OtherCMMG NPI
IL021622158OtherCMMG BLUE SHIELD
ILBG9706877OtherFEDERAL DEA