Provider Demographics
NPI:1407161086
Name:AUDREY M SIM PLLC
Entity Type:Organization
Organization Name:AUDREY M SIM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-872-2580
Mailing Address - Street 1:25915 HARPER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3770
Mailing Address - Country:US
Mailing Address - Phone:586-872-2580
Mailing Address - Fax:586-872-2689
Practice Address - Street 1:25915 HARPER AVE STE B
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3770
Practice Address - Country:US
Practice Address - Phone:586-872-2580
Practice Address - Fax:586-872-2689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-08
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty