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NPI Code Detail

MEDICARE: DR. SIMONE SIDEL D.V.M.

MEDICARE: DR. SIMONE SIDEL D.V.M.
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
1174M00000XVeterinarian090010968IL

General Provider Information

NPI Number : 1922418714
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SIMONE SIDEL D.V.M.
Provider Business Mailing Address
First Line : 3219 N CLARK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-1997
Country : US
Telephone Number : 773-327-4446
Fax Number : 773-327-9447
Provider Business Practice Location Address
First Line : 3219 N CLARK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-1997
Country : US
Telephone Number : 773-327-4446
Fax Number : 773-327-9447
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2014
Last Update Date : 05/01/2014

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