MEDICARE: SHERRY D SIMMONS M.D.

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
1	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1316141849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY D SIMMONS M.D.

Provider Business Mailing Address
First Line	:	2609 PARSLEY LN
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-7027
Country	:	US
Telephone Number	:	217-698-8607
Fax Number	:	217-698-8643

Provider Business Practice Location Address
First Line	:	4525 WABASH AVE
Second Line	:	SUITE 2
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-7037
Country	:	US
Telephone Number	:	217-698-8607
Fax Number	:	217-698-8643

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	07/08/2007

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