Healthcare Provider Details

I. General information

NPI: 1841216256
Provider Name (Legal Business Name): LOUIS ROBERT SIMEONE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 SMITH ST
PROVIDENCE RI
02908-2034
US

IV. Provider business mailing address

DEPT 3010, PO BOX 986524
BOSTON MA
02298-6524
US

V. Phone/Fax

Practice location:
  • Phone: 401-331-8873
  • Fax: 401-331-9144
Mailing address:
  • Phone: 833-924-5546
  • Fax: 401-537-7241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberDPM00287
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: