Healthcare Provider Details

I. General information

NPI: 1225141427
Provider Name (Legal Business Name): STEVE SIMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 W 5TH AVE
GARY IN
46402-1703
US

IV. Provider business mailing address

1015 N SHELBY ST
GARY IN
46403-1446
US

V. Phone/Fax

Practice location:
  • Phone: 219-880-1190
  • Fax: 219-880-0783
Mailing address:
  • Phone: 219-938-0923
  • Fax: 219-938-0923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number01027455
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: