Provider Demographics
NPI:1649613852
Name:MICHAEL W SIMON, M.D.
Entity type:Organization
Organization Name:MICHAEL W SIMON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-277-6516
Mailing Address - Street 1:610 E BRANNON RD
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-6066
Mailing Address - Country:US
Mailing Address - Phone:859-277-6516
Mailing Address - Fax:859-277-1521
Practice Address - Street 1:610 E BRANNON RD
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-6066
Practice Address - Country:US
Practice Address - Phone:859-277-6516
Practice Address - Fax:859-277-1521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty