Provider Demographics
NPI:1740462910
Name:MICHAEL H. SIMONS D.P.M. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MICHAEL H. SIMONS D.P.M. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:SIMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-861-4630
Mailing Address - Street 1:18111 BROOKHURST ST
Mailing Address - Street 2:SUITE 3400
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6728
Mailing Address - Country:US
Mailing Address - Phone:714-861-4630
Mailing Address - Fax:714-861-4631
Practice Address - Street 1:18111 BROOKHURST STREET
Practice Address - Street 2:SUITE 3400
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6728
Practice Address - Country:US
Practice Address - Phone:714-861-4630
Practice Address - Fax:714-861-4631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1388213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0374540001Medicare NSC