Healthcare Provider Details

I. General information

NPI: 1265433015
Provider Name (Legal Business Name): MICHAEL EVAN SIMONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

1710 CUMBERLAND FALLS HWY
CORBIN KY
40701-2727
US

IV. Provider business mailing address

1710 CUMBERLAND FALLS HWY
CORBIN KY
40701-2727
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-6700
  • Fax: 606-528-6513
Mailing address:
  • Phone: 606-528-6700
  • Fax: 606-528-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25912
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: