Provider Demographics
NPI:1811042732
Name:LOUIS R. SIMEONE,DPM,LTD
Entity Type:Organization
Organization Name:LOUIS R. SIMEONE,DPM,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SIMEONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:401-331-8873
Mailing Address - Street 1:1180 SMITH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02908-2034
Mailing Address - Country:US
Mailing Address - Phone:401-331-8873
Mailing Address - Fax:401-331-9144
Practice Address - Street 1:1180 SMITH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-2034
Practice Address - Country:US
Practice Address - Phone:401-331-8873
Practice Address - Fax:401-331-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00287213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9002751Medicaid
RIU67155Medicare UPIN