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General NPI Number Information
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NPI Number | 1417286121
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Entity Type | Individual
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Provider Name | SIMON J. MCCOY D.P.M
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Gender | Male
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Dates
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Enumeration Date | 12/09/2009
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 219 STATE ST
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City | HARBOR BEACH
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State | MI
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Zip | 48441-1206
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Country | US
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Telephone | 810-535-5507
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Fax | 810-535-5578
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Provider Business Mailing Address
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Address Line | PO BOX 282
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City | HARBOR BEACH
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State | MI
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Zip | 48441-0282
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Country | US
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Telephone | 810-535-5507
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Fax | 810-535-5578
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901002343
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5901002343
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License Number State | MI
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