Healthcare Provider Details

I. General information

NPI: 1518114313
Provider Name (Legal Business Name): PATRICK E. SIMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD
WINFIELD IL
60190
US

IV. Provider business mailing address

680 NORTH LAKE SHORE DRIVE 1000
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 630-938-6161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberAN5240394 6069
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number65606-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036-140724
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number036140724
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036140724
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: