Provider Demographics
NPI:1710100938
Name:SIMON, MELISSA M (DO)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:SIMON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DAVIDSON ST NW
Mailing Address - Street 2:
Mailing Address - City:ELKADER
Mailing Address - State:IA
Mailing Address - Zip Code:52043-9015
Mailing Address - Country:US
Mailing Address - Phone:563-245-7000
Mailing Address - Fax:
Practice Address - Street 1:901 DAVIDSON ST NW
Practice Address - Street 2:
Practice Address - City:ELKADER
Practice Address - State:IA
Practice Address - Zip Code:52043-9015
Practice Address - Country:US
Practice Address - Phone:563-245-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52306-21207Q00000X
390200000X
IA4252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program