Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 2901020232 | MI |
Y | 213EG0000X | General Practice | 2901020232 | MI |
NPI | 1003105412 |
---|---|
Provider Name | Nick Simone |
First Address | Ann Arbor, MI 48109-1078 |
Second Address | Ann Arbor, MI 48109-1078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2011 |
Last Update Date | 06/04/2011 |