Individual
SIDNEY KAY SIMONIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1421 E. 12 MILE, BLDG. A, MADISON HEIGHTS, MI 48071-2653
(248) 547-6656
(248) 547-5407
Mailing address
1421 E 12 MILE RD BLDG A, MADISON HEIGHTS, MI 48071-2653
(248) 547-6656
(248) 547-5407
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
SS0007420
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139455411
—
MI
01
—
180008618
MRRR
MI
01
—
1856303004
BCN
MI
01
—
382318591
COMMERCIAL
MI
01
—
5630300
BLUE CROSS BLUE SHIELD
MI
01
—
8631110001
MRPB
MI
Enumeration date
06/14/2006
Last updated
06/03/2011
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