Healthcare Provider Details

I. General information

NPI: 1992912042
Provider Name (Legal Business Name): GEZA SIMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 BLAINE AVE
INVER GROVE HEIGHTS MN
55076
US

IV. Provider business mailing address

2901 BROOKWOOD TER
MINNEAPOLIS MN
55410-2415
US

V. Phone/Fax

Practice location:
  • Phone: 651-450-8000
  • Fax: 651-450-8066
Mailing address:
  • Phone: 612-920-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22952
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: