MEDICARE: EDWIN K SIMON 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	2084P0800X	Psychiatry Physician	036109810	IL
2	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	36.10981	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376503292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWIN K SIMON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 610
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-0610
Country	:	US
Telephone Number	:	847-473-4357
Fax Number	:	847-578-8671

Provider Business Practice Location Address
First Line	:	830 W END CT
Second Line	:	SUITE 400
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-1344
Country	:	US
Telephone Number	:	847-249-6910
Fax Number	:	847-249-6950

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	10/13/2009

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