Provider Demographics
NPI:1154373918
Name:SIMMS, MARK D (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:SIMMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13800 W NORTH AVE
Mailing Address - Street 2:CHILD DEVELOPMENT CENTER OF CHW
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4977
Mailing Address - Country:US
Mailing Address - Phone:262-432-6600
Mailing Address - Fax:262-432-6604
Practice Address - Street 1:13800 W NORTH AVE
Practice Address - Street 2:CHILD DEVELOPMENT CENTER OF CHW
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4977
Practice Address - Country:US
Practice Address - Phone:262-432-6600
Practice Address - Fax:262-432-6604
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI358012080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
002000135ZOtherHUMANA
WI1154373918Medicaid
002000135ZOtherHUMANA
WI680860760Medicare PIN
WI736012015Medicare PIN
E47485Medicare UPIN