Healthcare Provider Details

I. General information

NPI: 1811042732
Provider Name (Legal Business Name): LOUIS R. SIMEONE,DPM,LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 SMITH ST 1ST FLOOR
PROVIDENCE RI
02908-2034
US

IV. Provider business mailing address

1180 SMITH ST 1ST FLOOR
PROVIDENCE RI
02908-2034
US

V. Phone/Fax

Practice location:
  • Phone: 401-331-8873
  • Fax: 401-331-9144
Mailing address:
  • Phone: 401-331-8873
  • Fax: 401-331-9144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM00287
License Number StateRI

VIII. Authorized Official

Name: DR. LOUIS ROBERT SIMEONE
Title or Position: PRESIDENT
Credential: DPM
Phone: 401-331-8873