Provider Demographics
NPI:1598818270
Name:SIMAGA, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:SIMAGA
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 1:1600 S. LAKE PARK AVE
Mailing Address - Street 2:SUITE 1102
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6641
Mailing Address - Country:US
Mailing Address - Phone:219-736-6955
Mailing Address - Fax:219-736-6080
Practice Address - Street 1:1600 S LAKE PARK AVE
Practice Address - Street 2:SUITE 1102
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6641
Practice Address - Country:US
Practice Address - Phone:219-947-6960
Practice Address - Fax:219-947-6960
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010465782084N0400X
IN01046578A207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
84104OtherANTHEM
84104OtherANTHEM
497970IMedicare ID - Type Unspecified