Provider Demographics
NPI:1992775969
Name:SIMONE, REGINA (DO)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:SIMONE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:42000 6 MILE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-4336
Mailing Address - Country:US
Mailing Address - Phone:248-735-9100
Mailing Address - Fax:248-735-9101
Practice Address - Street 1:42000 6 MILE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-4336
Practice Address - Country:US
Practice Address - Phone:248-735-9100
Practice Address - Fax:248-735-9101
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G57476Medicare UPIN