Provider Demographics
NPI:1881776359
Name:SIMONS, STEPHEN M (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:SIMONS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:707 E CEDAR ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2057
Mailing Address - Country:US
Mailing Address - Phone:574-335-6214
Mailing Address - Fax:574-335-6215
Practice Address - Street 1:611 E. DOUGLAS ROAD
Practice Address - Street 2:STE 137
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545
Practice Address - Country:US
Practice Address - Phone:574-335-6214
Practice Address - Fax:574-335-6215
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2016-09-14
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Provider Licenses
StateLicense IDTaxonomies
IN01034571207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200002120Medicaid
IN738460QQQMedicare PIN
INE06637Medicare UPIN