MEDICARE: DR. LESLIE L SIMONTON-SMITH 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	207V00000X	Obstetrics & Gynecology Physician	036069531	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	160050341	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	117129	OTHER	IL	HEALTHLINK
2	4126930	OTHER	IL	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417023284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE L SIMONTON-SMITH M.D.

Provider Business Mailing Address
First Line	:	8 CUSUMANO PROFESSIONAL PLAZA DR
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6736
Country	:	US
Telephone Number	:	618-244-4800
Fax Number	:	618-241-1746

Provider Business Practice Location Address
First Line	:	8 CUSUMANO PROFESSIONAL PLAZA DR
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6736
Country	:	US
Telephone Number	:	618-244-4800
Fax Number	:	618-241-1746

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

Provider Enumeration Date	:	11/25/2006
Last Update Date	:	03/07/2014

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Directions to “ DR. LESLIE L SIMONTON-SMITH M.D.” Practice Location

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