Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 036054963 | IL |
NPI | 1043355530 |
---|---|
Provider Name | Dr. Robert D Zimmerman |
First Address | Oak Park, IL 60302-2566 |
Second Address | Oak Park, IL 60302-2566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 27/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036054963 | (05) | IL |
D93399 | (02) | IL |