Provider Demographics
NPI:1508028135
Name:HELGE ULRICH SIMON M.D
Entity Type:Organization
Organization Name:HELGE ULRICH SIMON M.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HELGE
Authorized Official - Middle Name:ULRICH
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-269-8346
Mailing Address - Street 1:36060 EUCLID AVE
Mailing Address - Street 2:107
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4656
Mailing Address - Country:US
Mailing Address - Phone:440-269-8346
Mailing Address - Fax:440-975-5763
Practice Address - Street 1:36060 EUCLID AVE
Practice Address - Street 2:107
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4656
Practice Address - Country:US
Practice Address - Phone:440-269-8346
Practice Address - Fax:440-975-5763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079840207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2481425Medicaid
OHSI4132463Medicare PIN
OH2481425Medicaid