Provider Demographics
NPI:1760894372
Name:SVETLANA SIMOVIC, M.D.
Entity Type:Organization
Organization Name:SVETLANA SIMOVIC, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/SELF EMPLOYED
Authorized Official - Prefix:DR
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-269-0964
Mailing Address - Street 1:15 CROCUS PL
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2810
Mailing Address - Country:US
Mailing Address - Phone:507-269-0964
Mailing Address - Fax:612-888-9311
Practice Address - Street 1:825 NICOLLET MALL
Practice Address - Street 2:SUITE # 614
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2606
Practice Address - Country:US
Practice Address - Phone:612-455-3433
Practice Address - Fax:612-888-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-30
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty