Provider Demographics
NPI:1235484023
Name:SIMONSEN, ADAM DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:DAVID
Last Name:SIMONSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 CHATFIELD DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2667
Mailing Address - Country:US
Mailing Address - Phone:712-229-7889
Mailing Address - Fax:
Practice Address - Street 1:1120 SOUTH DR
Practice Address - Street 2:FESLER HALL RM 204
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5135
Practice Address - Country:US
Practice Address - Phone:317-274-0076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125062311208600000X
IN11017043A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery