MEDICARE: CAROLINA ANDREA SIMUNOVIC MD

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	207N00000X	Dermatology Physician	MD60671235	WA

General Provider Information

NPI Number	:	1578839494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA ANDREA SIMUNOVIC MD

Provider Business Mailing Address
First Line	:	1959 NE PACIFIC ST RM BB1353
Second Line	:	BOX 356524
City	:	SEATTLE
State	:	WA
Zip	:	98195-6524
Country	:	US
Telephone Number	:	206-543-5290
Fax Number	:

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC ST RM BB-1353
Second Line	:	BOX 356524
City	:	SEATTLE
State	:	WA
Zip	:	98195-6524
Country	:	US
Telephone Number	:	206-543-5290
Fax Number	:

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

Provider Enumeration Date	:	03/25/2012
Last Update Date	:	12/17/2021

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