Provider Demographics
NPI:1639107527
Name:SIMS, GINA E (DPM)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:E
Last Name:SIMS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 E 53RD ST
Mailing Address - Street 2:SUITE 918
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4557
Mailing Address - Country:US
Mailing Address - Phone:773-643-8400
Mailing Address - Fax:773-643-0430
Practice Address - Street 1:1525 E 53RD ST
Practice Address - Street 2:SUITE 918
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4557
Practice Address - Country:US
Practice Address - Phone:773-643-8400
Practice Address - Fax:773-643-0430
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00191736OtherRAILROAD MEDICARE
IL60001495OtherBCBS
IL60001495OtherBCBS
ILP00191736OtherRAILROAD MEDICARE