Provider Demographics
NPI:1538125935
Name:SIMON, DANIEL I (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:I
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:LAKESIDE 3001
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-5038
Practice Address - Country:US
Practice Address - Phone:216-844-8151
Practice Address - Fax:216-844-8318
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71840207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH364015OtherWELLCARE
OH5452126OtherAETNA
OH000000224443OtherUNISON
OH751184OtherBUCKEYE
OH2686437Medicaid
OHP00337974OtherRAILROAD MEDICARE
OH000000539520OtherANTHEM
OHP00449230OtherRAILROAD MEDICARE
OHP00337974OtherRAILROAD MEDICARE
OH000000539520OtherANTHEM
OH2686437Medicaid