Provider Demographics
NPI:1265433015
Name:SIMONS, MICHAEL EVAN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EVAN
Last Name:SIMONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 CUMBERLAND FALLS HWY
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2727
Mailing Address - Country:US
Mailing Address - Phone:606-528-6700
Mailing Address - Fax:606-528-6513
Practice Address - Street 1:1710 CUMBERLAND FALLS HWY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2727
Practice Address - Country:US
Practice Address - Phone:606-528-6700
Practice Address - Fax:606-528-6513
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2017-05-09
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
KY25912207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64259120Medicaid
KY100012500Medicare PIN
KY64259120Medicaid
KY5834001OtherAETNA HEALTH PLANS
KY29-00140OtherUNITED HEALTHCARE
KY64259120Medicaid
KY000269110OtherHUMANA
KY0575601Medicare ID - Type Unspecified
KY64259120Medicaid