Provider Demographics
NPI:1215003355
Name:SIMONS, MITCHELL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:E
Last Name:SIMONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4243 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6645
Mailing Address - Country:US
Mailing Address - Phone:513-794-5107
Mailing Address - Fax:513-791-2680
Practice Address - Street 1:4243 HUNT RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-6645
Practice Address - Country:US
Practice Address - Phone:513-794-5107
Practice Address - Fax:513-791-2680
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21522207L00000X, 207LP2900X
OH35050545207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH164264900OtherACS-DEPT OF LABOR
2440820000OtherPASSPORT ADVANTAGE MCR MC
KY64215221Medicaid
000000364540OtherANTHEM-PAIN MANAGEMENT
OH050074221OtherRAILROAD MEDICARE
000000077084OtherANTHEM - ANESTHESIOLOGY
OH284326OtherAMERIGROUP MEDICAID MCO
KY050073296OtherRAILROAD MEDICARE
OH0628404Medicaid
KY164264200OtherACS-DEPT OF LABOR
OH0870273Medicare PIN
000000077084OtherANTHEM - ANESTHESIOLOGY
OH050074221OtherRAILROAD MEDICARE