Provider Demographics
NPI:1528157500
Name:SIMON, LEANORE MIRIAM (MBBS)
Entity type:Individual
Prefix:
First Name:LEANORE
Middle Name:MIRIAM
Last Name:SIMON
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 KESSLER ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2553
Mailing Address - Country:US
Mailing Address - Phone:913-632-9810
Mailing Address - Fax:913-632-9828
Practice Address - Street 1:7450 KESSLER ST STE 205
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2553
Practice Address - Country:US
Practice Address - Phone:913-632-9810
Practice Address - Fax:913-632-9828
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN490472084N0400X, 2084N0600X
KS429762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology