1598818270 NPI number — MARK A SIMAGA MD

Table of content: MARK A SIMAGA MD (NPI 1598818270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598818270 NPI number — MARK A SIMAGA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMAGA
Provider First Name:
MARK
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1598818270
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 S. LAKE PARK AVE
Provider Second Line Business Mailing Address:
SUITE 1102
Provider Business Mailing Address City Name:
HOBART
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46342-6641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-736-6955
Provider Business Mailing Address Fax Number:
219-736-6080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 S LAKE PARK AVE
Provider Second Line Business Practice Location Address:
SUITE 1102
Provider Business Practice Location Address City Name:
HOBART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46342-6641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-947-6960
Provider Business Practice Location Address Fax Number:
219-947-6960
Provider Enumeration Date:
01/18/2007

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:  01046578 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207T00000X , with the licence number: 01046578A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 84104 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".




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