Provider Demographics
NPI:1710155627
Name:SIMMONS, MILTON FOSS (MD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:FOSS
Last Name:SIMMONS
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 1:18658 GEORGE WASHINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2552
Mailing Address - Country:US
Mailing Address - Phone:248-569-0404
Mailing Address - Fax:248-569-0536
Practice Address - Street 1:18658 GEORGE WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2552
Practice Address - Country:US
Practice Address - Phone:248-569-0404
Practice Address - Fax:248-569-0536
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301O24966174400000X
MI4301024966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine