Provider Demographics
NPI:1104925023
Name:SIMONS, RUTH MARGARET (MD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:MARGARET
Last Name:SIMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776347
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6347
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:
Practice Address - Street 1:3 AUDUBON PLAZA DR STE 610
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1362
Practice Address - Country:US
Practice Address - Phone:502-636-8334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 38762207R00000X
KY38762207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
50007366OtherPASSPORT
KYP00915027OtherMEDICARE RR
KY64104961Medicaid
KY64104961Medicaid
KYP400032644Medicare Oscar/Certification
50007366OtherPASSPORT
I33856Medicare UPIN
P400032644Medicare Oscar/Certification