Provider Demographics
NPI:1497769624
Name:SIMONE, PIERO ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:PIERO
Middle Name:ANTHONY
Last Name:SIMONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:29245 RYAN RD
Mailing Address - Street 2:#100
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092
Mailing Address - Country:US
Mailing Address - Phone:586-558-5891
Mailing Address - Fax:586-558-8338
Practice Address - Street 1:29245 RYAN RD
Practice Address - Street 2:#100
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092
Practice Address - Country:US
Practice Address - Phone:586-558-5891
Practice Address - Fax:586-558-8338
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066663207W00000X
MIPS066663207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4397424Medicaid
MIG96569Medicare UPIN
MI4397424Medicaid