MEDICARE: DR. SALVADOR MIGUEL SIMO 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	207QA0401X	Addiction Medicine (Family Medicine) Physician	0044968	FL
2	208000000X	Pediatrics Physician	0044968	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962465054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALVADOR MIGUEL SIMO M.D.

Provider Business Mailing Address
First Line	:	12008 SOUTHSHORE BLVD.
Second Line	:	STE. 101
City	:	WELLINGTON
State	:	FL
Zip	:	33414-8502
Country	:	US
Telephone Number	:	561-429-3812
Fax Number	:	561-429-3891

Provider Business Practice Location Address
First Line	:	1497 FOREST HILL BLVD STE E
Second Line	:
City	:	LAKE CLARKE SHORES
State	:	FL
Zip	:	33406-6052
Country	:	US
Telephone Number	:	561-433-5687
Fax Number	:

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/15/2020

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