MEDICARE: LEE T SIMON MD INC

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	207X00000X	Orthopaedic Surgery Physician	043640	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447553185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE T SIMON MD INC

Provider Business Mailing Address
First Line	:	2222 OAK ST
Second Line	:
City	:	SALEM
State	:	OH
Zip	:	44460-2520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 OAK ST
Second Line	:
City	:	SALEM
State	:	OH
Zip	:	44460-2520
Country	:	US
Telephone Number	:	330-337-8739
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEE SIMON
Credential	:
Telephone Number	:	330-337-8739

Provider Enumeration Date	:	12/20/2010
Last Update Date	:	12/21/2010

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