MEDICARE: DR. MICHAEL R SIMON 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	207KA0200X	Allergy Physician	4301031929	MI

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	:	1740396951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL R SIMON MD

Provider Business Mailing Address
First Line	:	49 CASS ST S
Second Line	:	SUITE1B
City	:	BATTLE CREEK
State	:	MI
Zip	:	49017-2331
Country	:	US
Telephone Number	:	269-969-8920
Fax Number	:	269-969-8921

Provider Business Practice Location Address
First Line	:	4870 W CLARK RD
Second Line	:	SUITE 202
City	:	YPSILANTI
State	:	MI
Zip	:	48197-1104
Country	:	US
Telephone Number	:	734-434-5430
Fax Number	:	734-434-5762

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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