Healthcare Provider Details

I. General information

NPI: 1710100938
Provider Name (Legal Business Name): MELISSA M SIMON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 DAVIDSON ST NW
ELKADER IA
52043-9015
US

IV. Provider business mailing address

901 DAVIDSON ST NW
ELKADER IA
52043-9015
US

V. Phone/Fax

Practice location:
  • Phone: 563-245-7000
  • Fax:
Mailing address:
  • Phone: 563-245-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number52306-21
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4252
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: