Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036059275 | IL |
N | 207QA0505X | Family Doctor - Adult Medicine | 036059275 | IL |
NPI | 1194749218 |
---|---|
Provider Name | Dr. Patrick Zimmermann |
First Address | Collinsville, IL 62234-4061 |
Second Address | Collinsville, IL 62234-4061 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 11/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036059275 | (05) | IL |
C42766 | (02) | IL |