Provider Demographics
NPI:1841216256
Name:SIMEONE, LOUIS ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:ROBERT
Last Name:SIMEONE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 SMITH ST
Mailing Address - Street 2:
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:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM287213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9002751Medicaid
RIU67155Medicare UPIN