Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | IL | |
Y | 222Z00000X | Podiatrist | IL |
NPI | 1073507331 |
---|---|
Provider Name | Dr. Scott Allen Zimmerman |
First Address | Lombard, IL 60148-4977 |
Second Address | Lombard, IL 60148-4977 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2005 |
Last Update Date | 25/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T37989 | (02) |