MEDICARE: MR. GERALD SIMON MD

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	36066840	IL
2	207R00000X	Internal Medicine Physician	036066840	IL

General Provider Information

NPI Number	:	1861450330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERALD SIMON MD

Provider Business Mailing Address
First Line	:	120 W 22ND ST STE 200
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1563
Country	:	US
Telephone Number	:	630-573-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6438 JOLIET RD STE 203
Second Line	:
City	:	COUNTRYSIDE
State	:	IL
Zip	:	60525-4624
Country	:	US
Telephone Number	:	708-352-5222
Fax Number	:	708-352-1576

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	02/01/2023

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