MEDICARE: ERIC RAUL SIMENTAL

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	2083S0010X	Sports Medicine (Preventive Medicine) Physician	2083S0010X	IL

General Provider Information

NPI Number	:	1760987515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC RAUL SIMENTAL

Provider Business Mailing Address
First Line	:	1014 CLAIM ST
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60505
Country	:	US
Telephone Number	:	630-674-0898
Fax Number	:

Provider Business Practice Location Address
First Line	:	1014 CLAIM ST
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60505
Country	:	US
Telephone Number	:	630-674-0898
Fax Number	:

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

Provider Enumeration Date	:	03/26/2018
Last Update Date	:	03/26/2018

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Directions to “ ERIC RAUL SIMENTAL ” Practice Location

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