Basic Information
| Provider Information | |||||||||
| NPI: | 1861450330 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMON | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 W 22ND ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305755000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6438 JOLIET RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | COUNTRYSIDE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605254624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083525222 | ||||||||
| FaxNumber: | 7083521576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036066840 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0300X | 36066840 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.