Provider Demographics
NPI:1275667321
Name:SIMONS, ANDREA K (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:K
Last Name:SIMONS
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:13105 SCHAVEY ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820
Mailing Address - Country:US
Mailing Address - Phone:517-668-6166
Mailing Address - Fax:517-668-6169
Practice Address - Street 1:13105 SCHAVEY ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820
Practice Address - Country:US
Practice Address - Phone:517-668-6166
Practice Address - Fax:517-668-6169
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5901002235213E00000X
MI1275661321213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI134902666Medicaid