Provider Demographics
NPI:1942217153
Name:SIMON, ELIZABETH M (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:M
Last Name:SIMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1401 DUGDALE CIRCLE
Mailing Address - Street 2:ANN KILEY CENTER
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085
Mailing Address - Country:US
Mailing Address - Phone:847-249-0600
Mailing Address - Fax:847-249-0967
Practice Address - Street 1:1401 DUGDALE CIRCLE
Practice Address - Street 2:ANN KILEY CENTER
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085
Practice Address - Country:US
Practice Address - Phone:847-249-0600
Practice Address - Fax:847-249-0967
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H83012Medicare UPIN
L98346Medicare ID - Type Unspecified