MEDICARE: DR. VINCENT SIMONE JR. DPM

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	213E00000X	Podiatrist	750	MN
2	213ES0103X	Foot & Ankle Surgery Podiatrist	750	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1205933533	OTHER		PREFERRED ONE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2700627	OTHER	MN	MEDICA

General Provider Information

NPI Number	:	1427053917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT SIMONE JR. DPM

Provider Business Mailing Address
First Line	:	1700 UNIVERSITY AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-3727
Country	:	US
Telephone Number	:
Fax Number	:	651-748-3117

Provider Business Practice Location Address
First Line	:	2945 HAZELWOOD ST
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1241
Country	:	US
Telephone Number	:	651-232-7800
Fax Number	:

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	04/29/2025

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