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General NPI Number Information
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NPI Number | 1295710820
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Entity Type | Individual
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Provider Name | STEPHEN D. SIMONICH M.D
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Gender | Male
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 23910 KATY FWY STE 201
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City | KATY
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State | TX
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Zip | 77494-1477
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Country | US
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Telephone | 713-486-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 13635 MICHEL RD
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City | TOMBALL
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State | TX
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Zip | 77375-6410
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Country | US
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Telephone | 281-351-7261
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Fax | 281-351-2515
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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 | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | TEMPORARY
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | M2808
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License Number State | TX
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