Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 62843 | WI |
N | 208200000X | Surgeon | 44600 | CO |
N | 208600000X | Surgeon | 44600 | CO |
N | 208200000X | Surgeon | 62843 | WI |
N | 208600000X | Surgeon | 62843 | WI |
NPI | 1477579902 |
---|---|
Provider Name | Michael Zimmerman |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 19/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01888331 | (05) | CO |
1477579902 | (05) | WI |