Provider Demographics
NPI:1861450330
Name:SIMON, GERALD (MD)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:
Practice Address - Street 1:6438 JOLIET RD STE 203
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-4624
Practice Address - Country:US
Practice Address - Phone:708-352-5222
Practice Address - Fax:708-352-1576
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36066840207RG0300X
IL036066840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
364138353OtherTAX ID
208342OtherMEDICARE GROUP NUMBER
K19854Medicare PIN
400480OtherMEDICARE GROUP NUMBER
C37687Medicare PIN
K19852Medicare PIN