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General NPI Number Information
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NPI Number | 1114324969
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Entity Type | Organization
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Legal Business Name | SIMMONS MEDICAL GROUP PC
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 38525 8 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48152-1012
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Country | US
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Telephone | 734-542-5512
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Fax |
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Provider Business Mailing Address
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Address Line | 38525 8 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48152-1012
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Country | US
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Telephone | 734-542-5512
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | IAN JOSHUA TAROCKOFF
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Credential |
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Telephone | 734-542-5512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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