Provider Demographics
NPI:1376514257
Name:REGINA SIMONE DO PC
Entity Type:Organization
Organization Name:REGINA SIMONE DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-735-9100
Mailing Address - Street 1:42000 6 MILE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-4336
Mailing Address - Country:US
Mailing Address - Phone:248-735-9100
Mailing Address - Fax:248-735-9101
Practice Address - Street 1:42000 6 MILE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-4336
Practice Address - Country:US
Practice Address - Phone:248-735-9100
Practice Address - Fax:248-735-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G57476Medicare UPIN
MI0P25600Medicare PIN