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NPI Code Detail

MEDICARE: MRS. KATIE ELIZABETH SIMKOW N.P.

MEDICARE: MRS. KATIE ELIZABETH SIMKOW N.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LG0600XGerontology Nurse Practitioner4704273155MI
2363LP2300XPrimary Care Nurse Practitioner4704273155MI

General Provider Information

NPI Number : 1053770305
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATIE ELIZABETH SIMKOW N.P.
Provider Business Mailing Address
First Line : 30091 MUIRLAND DR
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48334-2052
Country : US
Telephone Number : 734-578-8870
Fax Number :
Provider Business Practice Location Address
First Line : 8365 N NEWBURGH RD
Second Line :
City : WESTLAND
State : MI
Zip : 48185-1149
Country : US
Telephone Number : 734-416-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2016
Last Update Date : 02/15/2016

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