Provider Demographics
NPI:1437420486
Name:KREJCI-SIMMONS, CHARLENE ROBERTA (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:ROBERTA
Last Name:KREJCI-SIMMONS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-8712
Mailing Address - Country:US
Mailing Address - Phone:330-995-0218
Mailing Address - Fax:330-995-0218
Practice Address - Street 1:945 LAKE AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-8712
Practice Address - Country:US
Practice Address - Phone:330-995-0218
Practice Address - Fax:330-995-0218
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.001993213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery