Provider Demographics
NPI:1073507331
Name:ZIMMERMAN, SCOTT ALLEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALLEN
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E 22ND ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4977
Mailing Address - Country:US
Mailing Address - Phone:630-953-8088
Mailing Address - Fax:630-953-8094
Practice Address - Street 1:10 E 22ND ST
Practice Address - Street 2:SUITE 205
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4977
Practice Address - Country:US
Practice Address - Phone:630-953-8088
Practice Address - Fax:630-953-8094
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL700441Medicare PIN
IL980290Medicare ID - Type UnspecifiedGROUP NUMBER
T37989Medicare UPIN
IL0506240001Medicare NSC
IL700440Medicare PIN