Provider Demographics
NPI:1295807360
Name:ABELSON, SIMON C (MD)
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:C
Last Name:ABELSON
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 1:7085 SW 47TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4652
Mailing Address - Country:US
Mailing Address - Phone:786-269-7939
Mailing Address - Fax:305-667-6317
Practice Address - Street 1:7085 SW 47TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4652
Practice Address - Country:US
Practice Address - Phone:786-269-7939
Practice Address - Fax:305-667-6317
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 93384207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13737OtherBLUE CROSS BLUE SHIELD
FLAF464ZMedicare PIN
FLI04944Medicare UPIN