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PHYLLIS MARTIN-SIMMERMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
253 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1501
(765) 448-8000
(765) 448-8335
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01029841A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000183094
ANTHEM PROVIDER NUMBER
IN
05
100088630
IN
01
10825553
CAQH NUMBER
IN
01
9274775
PHCS PID NUMBER
IN
05
MA15766030
IN
Enumeration date
03/15/2006
Last updated
01/27/2021
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