Provider Demographics
NPI:1962763359
Name:SIMONES, ANN ADAIR CODY (MD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:ADAIR CODY
Last Name:SIMONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:ADAIR
Other - Last Name:CODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9117 TERRA VERDE TRL
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-5256
Mailing Address - Country:US
Mailing Address - Phone:952-270-6227
Mailing Address - Fax:
Practice Address - Street 1:502 EAST SECOND STREET
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1951
Practice Address - Country:US
Practice Address - Phone:218-727-8762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-03
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN59261208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program