MEDICARE: DR. LORI ELIZABETH SIMENAUER M.D.

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	208000000X	Pediatrics Physician	36107544	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	809840	OTHER	IL	MEDICARE GROUP

General Provider Information

NPI Number	:	1780670794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI ELIZABETH SIMENAUER M.D.

Provider Business Mailing Address
First Line	:	420 NE GLEN OAK AVE
Second Line	:	SUITE 201
City	:	PEORIA
State	:	IL
Zip	:	61603-3105
Country	:	US
Telephone Number	:	888-627-5673
Fax Number	:	309-683-5669

Provider Business Practice Location Address
First Line	:	420 NE GLEN OAK AVE
Second Line	:	SUITE 201
City	:	PEORIA
State	:	IL
Zip	:	61603-3105
Country	:	US
Telephone Number	:	888-627-5673
Fax Number	:	309-683-5669

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	01/17/2013

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