Provider Demographics
NPI:1447349915
Name:SIMMONS, MICHAEL (DPM,FACFAS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:DPM,FACFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 BAPTIST WAY
Mailing Address - Street 2:#101
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7600
Mailing Address - Country:US
Mailing Address - Phone:305-246-4774
Mailing Address - Fax:305-248-4086
Practice Address - Street 1:975 BAPTIST WAY
Practice Address - Street 2:#101
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7600
Practice Address - Country:US
Practice Address - Phone:305-246-4774
Practice Address - Fax:305-248-4086
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-0002754213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390443100Medicaid
E1272ZMedicare PIN
FLU72304Medicare UPIN
FL1148440001Medicare NSC