Provider Demographics
NPI:1972896520
Name:OLSTEIN, SIMON (MD)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:OLSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5656 E ORANGE BLOSSOM LN STE 5
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-8139
Mailing Address - Country:US
Mailing Address - Phone:602-601-7429
Mailing Address - Fax:602-601-7428
Practice Address - Street 1:5656 E ORANGE BLOSSOM LN STE 5
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-8139
Practice Address - Country:US
Practice Address - Phone:602-601-7429
Practice Address - Fax:602-601-7428
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ8589207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ226086Medicaid