Basic Information
| Provider Information | |||||||||
| NPI: | 1194895680 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMPSON | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 SIERRA DR 400 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461437241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178658988 | ||||||||
| FaxNumber: | 3178598590 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 S LAKE PARK AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | HOBART | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463426790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199476122 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 02/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036112784 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 01065834A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 54865-020 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QB0002X | 01065834A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine | Bariatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | PAYEE 1 | 05 | IL | MEDICAID |