Healthcare Provider Details

I. General information

NPI: 1033047097
Provider Name (Legal Business Name): LEGACY RHEUMATOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ISLE VERDE WAY
PALM BEACH GARDENS FL
33418-1710
US

IV. Provider business mailing address

105 ISLE VERDE WAY
PALM BEACH GARDENS FL
33418-1710
US

V. Phone/Fax

Practice location:
  • Phone: 561-747-1987
  • Fax: 561-747-1313
Mailing address:
  • Phone: 561-747-1987
  • Fax: 561-747-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EKATERINA SIMAKOVA
Title or Position: PRESIDENT
Credential: MD
Phone: 561-747-1987