=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386964955
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SIMON R MUCHA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2010
-----------------------------------------------------
Last Update Date | 07/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9500 EUCLID AVE # L2-330
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44195-2360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-444-2912
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 UNIVERSITY DR
-----------------------------------------------------
City | HERSHEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17033-2360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-531-8521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 35.129651
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------