MEDICARE: DR. MICHAEL SIMON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	LP04894	RI
2	207RP1001X	Pulmonary Disease Physician	291140	MA

General Provider Information

NPI Number	:	1366896912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SIMON M.D.

Provider Business Mailing Address
First Line	:	593 EDDY ST
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02903-4923
Country	:	US
Telephone Number	:	401-444-8410
Fax Number	:	401-444-5914

Provider Business Practice Location Address
First Line	:	1030 PRESIDENT AVE STE 210
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02720-5928
Country	:	US
Telephone Number	:	508-973-1780
Fax Number	:	508-973-7338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	01/22/2025

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Directions to “ DR. MICHAEL SIMON M.D.” Practice Location

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