Basic Information
| Provider Information | |||||||||
| NPI: | 1700096088 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMO | ||||||||
| FirstName: | KERRI | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2121 HUGHES DR | ||||||||
| Address2: | SUITE 710 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436063845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912671 | ||||||||
| FaxNumber: | 4192912680 | ||||||||
| Practice Location | |||||||||
| Address1: | 2121 HUGHES DR | ||||||||
| Address2: | SUITE 710 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436063845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192912671 | ||||||||
| FaxNumber: | 4192912680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 01/18/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2007-00092 | NC | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 35121983 | OH | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.