Provider Demographics
NPI:1790769875
Name:SIMPSON, SHEILA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25241 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-1404
Mailing Address - Country:US
Mailing Address - Phone:248-544-8644
Mailing Address - Fax:248-544-8876
Practice Address - Street 1:27483 DEQUINDRE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3491
Practice Address - Country:US
Practice Address - Phone:248-544-8644
Practice Address - Fax:248-544-8876
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301406553208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI250008193OtherRR MEDICARE
MIE90802OtherHAP
MI0637654OtherBCBS INDIVIDUAL
MI1790769875Medicaid
MI700H217350OtherBLUE SHIELD
MI0M50950-001Medicare ID - Type Unspecified
MIE90802Medicare UPIN
MI0M92440028Medicare PIN