Provider Demographics
NPI:1295710820
Name:SIMONICH, STEPHEN D (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:SIMONICH
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 1:13635 MICHEL RD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6410
Mailing Address - Country:US
Mailing Address - Phone:281-351-7261
Mailing Address - Fax:281-351-2515
Practice Address - Street 1:23910 KATY FWY STE 201
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1477
Practice Address - Country:US
Practice Address - Phone:713-486-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTEMPORARY204C00000X
TXM2808207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH49431Medicare UPIN