Individual
MARY KATHLEEN SIMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
333 N MICHIGAN AVE STE 1400, CHICAGO, IL 60601-4011
(312) 815-9660
Mailing address
1820 S WIGGINS AVE, SPRINGFIELD, IL 62704-3335
(217) 502-4306
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085008158
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/22/2020
Last updated
08/22/2021
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