Individual
DR. KENNETH SIMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
30163
WI
207ZP0101X
Anatomic Pathology Physician
30163
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002000133
HUMANA
—
05
—
1225089709
—
WI
Enumeration date
05/12/2006
Last updated
01/20/2015
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