Provider Demographics
NPI:1922027135
Name:PAUL B SIMMONS MD,PLLC
Entity Type:Organization
Organization Name:PAUL B SIMMONS MD,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PLLC
Authorized Official - Phone:989-953-4002
Mailing Address - Street 1:2981 HEALTH PARKWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3914
Mailing Address - Country:US
Mailing Address - Phone:989-953-4002
Mailing Address - Fax:989-953-7143
Practice Address - Street 1:2981 HEALTH PARKWAY
Practice Address - Street 2:SUITE A
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3914
Practice Address - Country:US
Practice Address - Phone:989-953-4002
Practice Address - Fax:989-953-7143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB46784Medicare UPIN
MI0N84920Medicare ID - Type Unspecified