Provider Demographics
NPI:1407077472
Name:SIMEK, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:SIMEK
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 1:501 W SCHROCK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8039
Mailing Address - Country:US
Mailing Address - Phone:614-794-5069
Mailing Address - Fax:614-797-4505
Practice Address - Street 1:501 W SCHROCK RD STE 103
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8039
Practice Address - Country:US
Practice Address - Phone:614-794-5069
Practice Address - Fax:614-797-4505
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37031208100000X
OH35.087168208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2956118Medicaid
OHSI4252321Medicare PIN