Provider Demographics
NPI:1700096088
Name:SIMO, KERRI A (MD)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:A
Last Name:SIMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 HUGHES DR
Mailing Address - Street 2:SUITE 710
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3845
Mailing Address - Country:US
Mailing Address - Phone:419-291-2671
Mailing Address - Fax:419-291-2680
Practice Address - Street 1:2121 HUGHES DR
Practice Address - Street 2:SUITE 710
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3845
Practice Address - Country:US
Practice Address - Phone:419-291-2671
Practice Address - Fax:419-291-2680
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00092208600000X
OH35121983208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery