Provider Demographics
NPI:1932295029
Name:SIMONS, MICHAEL HOWARD (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HOWARD
Last Name:SIMONS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:714-847-1150
Mailing Address - Fax:714-848-6976
Practice Address - Street 1:18111 BROOKHURST ST
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:714-847-1150
Practice Address - Fax:714-848-6976
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1388213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E13880Medicaid
P00110039OtherRAILROAD MEDICARE
CA0374540001Medicare NSC
P00110039OtherRAILROAD MEDICARE