Provider Demographics
NPI:1851761217
Name:SIMON, JULIE (PA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-364-6253
Mailing Address - Fax:517-364-6204
Practice Address - Street 1:1215 E. MICHIGAN AVE.
Practice Address - Street 2:7TH FL TOWER WEST
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912
Practice Address - Country:US
Practice Address - Phone:517-364-3380
Practice Address - Fax:517-364-3399
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2022-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601007550363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant