Healthcare Provider Details

I. General information

NPI: 1346236585
Provider Name (Legal Business Name): STEPHANIE SIMMONS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 OGDEN AVE SUITE 201
AURORA IL
60504-7222
US

IV. Provider business mailing address

2040 OGDEN AVE STE 201
AURORA IL
60504-7205
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-6886
  • Fax: 630-978-6806
Mailing address:
  • Phone: 630-978-6886
  • Fax: 630-978-6806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036-104639
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: