Healthcare Provider Details

I. General information

NPI: 1467405522
Provider Name (Legal Business Name): STEVEN G SIMENSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 JOLLY RD STE 240
OKEMOS MI
48864-3681
US

IV. Provider business mailing address

2525 JOLLY RD STE 240
OKEMOS MI
48864-3681
US

V. Phone/Fax

Practice location:
  • Phone: 989-729-4304
  • Fax: 989-729-4308
Mailing address:
  • Phone: 989-729-4304
  • Fax: 989-729-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35083816
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number35083816
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301503579
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: