Provider Demographics
NPI:1528012424
Name:SIMON, MATHEW J (DO)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:J
Last Name:SIMON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5861 CINEMA DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-1489
Mailing Address - Country:US
Mailing Address - Phone:513-248-8800
Mailing Address - Fax:513-248-8177
Practice Address - Street 1:5861 CINEMA DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1489
Practice Address - Country:US
Practice Address - Phone:513-248-8800
Practice Address - Fax:513-248-8177
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008504207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2668868Medicaid
OH2668868Medicaid
OHI56056Medicare UPIN