Provider Demographics
NPI:1700885761
Name:SIMON, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1951 SW 172ND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5593
Practice Address - Country:US
Practice Address - Phone:954-499-7696
Practice Address - Fax:954-499-7699
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2017-05-08
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Provider Licenses
StateLicense IDTaxonomies
FLME89935208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0195189OtherGHI
FL1193472OtherWELLCARE
FL773707OtherNHP
FLP0003130OtherFLORIDA HEALTHCARE PLUS
FL2116456OtherCIGNA
FL298813OtherAVMED
FL7072759OtherAETNA
FLM899351OtherPREFERRED MEDICAL PLAN
FLP00956378OtherRAILROAD MEDICARE
FL001110900Medicaid
FL50359OtherBLUE CROSS BLUE SHIELD
FL69212OtherHEALTH SUN HEALTH PLAN
FLM899353OtherPREFERRED MEDICAL PLAN
FLSG078455OtherVISTA
FL20784OtherMEDICA
FLP01712888OtherSIMPLY HEALTHCARE
FL50359VMedicare PIN
FL50359OtherBLUE CROSS BLUE SHIELD
FL20784OtherMEDICA