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General NPI Number Information
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NPI Number | 1073716445
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Entity Type | Individual
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Provider Name | SIMIL S. GALA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 09/15/2016
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Provider Practice Location Address
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Address Line | 1727 SHAWANO AVE
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City | GREEN BAY
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State | WI
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Zip | 54303-3268
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Country | US
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Telephone | 920-496-4700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19070
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City | GREEN BAY
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State | WI
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Zip | 54307-9070
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Country | US
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Telephone | 920-496-4700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036114652
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 56139-20
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License Number State | WI
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