MEDICARE: SHELDON SIMON D.P.M.

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	213E00000X	Podiatrist	119	KY
2	213E00000X	Podiatrist	07000335A	IN
3	213ES0000X	Sports Medicine Podiatrist	00119	KY
4	332BC3200X	Customized Equipment (DME)

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000045182	OTHER	KY	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922082957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELDON SIMON D.P.M.

Provider Business Mailing Address
First Line	:	1915 W PARRISH AVE
Second Line	:	STE 300
City	:	OWENSBORO
State	:	KY
Zip	:	42301-3519
Country	:	US
Telephone Number	:	270-683-4844
Fax Number	:	270-926-8366

Provider Business Practice Location Address
First Line	:	1915 W PARRISH AVE
Second Line	:	STE 300
City	:	OWENSBORO
State	:	KY
Zip	:	42301-3519
Country	:	US
Telephone Number	:	270-683-4844
Fax Number	:	270-926-8366

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	10/06/2015

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