Healthcare Provider Details

I. General information

NPI: 1386334985
Provider Name (Legal Business Name): SIMON MACDONALD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 11/14/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E. CHICAGO AVENUE
CHICAGO IL
60611
US

IV. Provider business mailing address

214 RUE CASTELNAU EST
MONTREAL QUEBEC
H2R 1P5
CA

V. Phone/Fax

Practice location:
  • Phone: 312-227-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125.081144
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: