1487655833 NPI number — DR. GALINA SIMKIN M.D.

Table of content: DR. GALINA SIMKIN M.D. (NPI 1487655833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487655833 NPI number — DR. GALINA SIMKIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMKIN
Provider First Name:
GALINA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487655833
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
227 ESTATE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60062-1100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3295 N ARLINGTON HEIGHTS RD
Provider Second Line Business Practice Location Address:
102
Provider Business Practice Location Address City Name:
ARLINGTON HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60004-1565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-650-9509
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  MC-1387 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 036-094324 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01623065 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 05-00386 . This is a "UNITED HEALTH CARE MN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 130020631 . This is a "UNITED HEALTH CARE GA3" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 5465736001 . This is a "CIGNA TN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 292346 . This is a "CCN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 364302228 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130020361 . This is a "UNITED HERALTH CARE GA3" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 113272100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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