MEDICARE: MARK A SIMAGA 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	2084N0400X	Neurology Physician	01046578	IN
2	207T00000X	Neurological Surgery Physician	01046578A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84104	OTHER		ANTHEM

General Provider Information

NPI Number	:	1598818270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A SIMAGA MD

Provider Business Mailing Address
First Line	:	1600 S. LAKE PARK AVE
Second Line	:	SUITE 1102
City	:	HOBART
State	:	IN
Zip	:	46342-6641
Country	:	US
Telephone Number	:	219-736-6955
Fax Number	:	219-736-6080

Provider Business Practice Location Address
First Line	:	1600 S LAKE PARK AVE
Second Line	:	SUITE 1102
City	:	HOBART
State	:	IN
Zip	:	46342-6641
Country	:	US
Telephone Number	:	219-947-6960
Fax Number	:	219-947-6960

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	12/17/2012

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Directions to “ MARK A SIMAGA MD” Practice Location

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