Provider Demographics
NPI:1902826092
Name:SIMMONS, PAUL B (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:B
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2981 HEALTH PARKWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3914
Mailing Address - Country:US
Mailing Address - Phone:989-953-4002
Mailing Address - Fax:989-953-7143
Practice Address - Street 1:2981 HEALTH PARKWAY
Practice Address - Street 2:SUITE A
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3914
Practice Address - Country:US
Practice Address - Phone:989-953-4002
Practice Address - Fax:989-953-7143
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301028129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4574378Medicaid
MI4574378Medicaid
MIB46784Medicare UPIN