Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 036097110 | IL |
N | 208000000X | Pediatrician | DO2300 | NV |
Y | 2080P0204X | Pediatric Emergency Doctor | DO2300 | NV |
NPI | 1215910245 |
---|---|
Provider Name | Todd Lewis Zimmerman |
First Address | Carol Stream, IL 60188-7904 |
Second Address | Elk Grove Vlg, IL 60007-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 11/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H82421 | (02) |