Provider Demographics
NPI:1700890969
Name:SIMON, CHARLA E (MD)
Entity Type:Individual
Prefix:
First Name:CHARLA
Middle Name:E
Last Name:SIMON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:EVANSTON HOSPITAL
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1206
Mailing Address - Fax:847-570-1248
Practice Address - Street 1:6810 N MCCORMICK BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-2709
Practice Address - Country:US
Practice Address - Phone:847-674-6900
Practice Address - Fax:847-329-4728
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-01-22
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Provider Licenses
StateLicense IDTaxonomies
IL036107475207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I09159Medicare UPIN