Provider Demographics
NPI:1427894898
Name:SIMM, MICHAEL CHARLES (RN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHARLES
Last Name:SIMM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 W VAN BUREN ST UNIT 1605
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3932
Mailing Address - Country:US
Mailing Address - Phone:360-840-8539
Mailing Address - Fax:
Practice Address - Street 1:1653 W CONGRESS PKWY # 12
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:312-942-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61068761163W00000X
IL041557178163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse