Provider Demographics
NPI:1598878266
Name:SIMAIKA, ABDALLAH (MD)
Entity type:Individual
Prefix:
First Name:ABDALLAH
Middle Name:
Last Name:SIMAIKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 DR WARREN TUTTLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946
Mailing Address - Country:US
Mailing Address - Phone:618-253-7671
Mailing Address - Fax:
Practice Address - Street 1:2797 APPLEGATE RD
Practice Address - Street 2:PO BOX 55
Practice Address - City:APPLEGATE
Practice Address - State:MI
Practice Address - Zip Code:48401-9752
Practice Address - Country:US
Practice Address - Phone:810-705-1964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044184207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL439162710Medicaid
ILA76062Medicare UPIN
IL439162710Medicaid