Provider Demographics
NPI:1437249125
Name:SIMON, BOZENA (MD)
Entity Type:Individual
Prefix:
First Name:BOZENA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 ROSEDALE DR
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1358
Mailing Address - Country:US
Mailing Address - Phone:262-512-0973
Mailing Address - Fax:262-512-0973
Practice Address - Street 1:11203 N BUNTROCK AVE
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-1857
Practice Address - Country:US
Practice Address - Phone:262-238-8988
Practice Address - Fax:262-238-0819
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI37239-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine