Provider Demographics
NPI:1881787372
Name:SIMONSON, MICHAEL L (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:SIMONSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9994
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69103-9994
Mailing Address - Country:US
Mailing Address - Phone:308-534-5370
Mailing Address - Fax:308-696-8349
Practice Address - Street 1:516 W LEOTA ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6533
Practice Address - Country:US
Practice Address - Phone:308-534-5370
Practice Address - Fax:308-534-3813
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE26195208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026413401Medicaid