Provider Demographics
NPI:1992054712
Name:KIM SIMIC MD INC
Entity type:Organization
Organization Name:KIM SIMIC MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-681-6830
Mailing Address - Street 1:4608 THORNBURY DR. W
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-0816
Mailing Address - Country:US
Mailing Address - Phone:219-681-6830
Mailing Address - Fax:
Practice Address - Street 1:297 W. FRANCISCAN DR.
Practice Address - Street 2:SUITE 108
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4858
Practice Address - Country:US
Practice Address - Phone:219-681-6830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040307B2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty