Basic Information
| Provider Information | |||||||||
| NPI: | 1912181017 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIMA | ||||||||
| FirstName: | BOGDAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 780 KUENZLI ST | ||||||||
| Address2: | STE 202 | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895020845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759825262 | ||||||||
| FaxNumber: | 7759825496 | ||||||||
| Practice Location | |||||||||
| Address1: | 1155 MILL ST | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759827878 | ||||||||
| FaxNumber: | 7759824196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2007 | ||||||||
| LastUpdateDate: | 05/05/2017 | ||||||||
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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 | 207R00000X | 4301091258 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 01065893A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 01065893 | IN | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 15909 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 201286570 | 05 | IN | MEDICAID | 000000924920 | 01 | IN | BCBS | OTHER |