Individual
MR. CHAD SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
70 KENNEDY PLZ UNIT 2, PROVIDENCE, RI 02903-2000
(310) 984-0156
Mailing address
70 KENNEDY PLZ UNIT 2, PROVIDENCE, RI 02903-2000
(310) 984-0156
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BHP831302102
BLUECROSS BLUESHIELD
IL
Enumeration date
04/26/2019
Last updated
04/26/2019
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