Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | OH000039 | PA |
N | 222Z00000X | Podiatrist | OH000039 | PA |
Y | 224P00000X | Prosthetist | PO000019 | PA |
NPI | 1144712423 |
---|---|
Provider Name | Mr. Michael Taylor Zimmerman I |
First Address | Ligonier, PA 15658-9207 |
Second Address | Monroeville, PA 15146-1614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2018 |
Last Update Date | 03/06/2018 |