Healthcare Provider Details

I. General information

NPI: 1194895680
Provider Name (Legal Business Name): MICHAEL H. SIMPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 02/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S LAKE PARK AVE STE 200
HOBART IN
46342-6790
US

IV. Provider business mailing address

1040 SIERRA DR 400
GREENWOOD IN
46143-7241
US

V. Phone/Fax

Practice location:
  • Phone: 219-947-6122
  • Fax:
Mailing address:
  • Phone: 317-865-8988
  • Fax: 317-859-8590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036112784
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01065834A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number54865-020
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number01065834A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: