Provider Demographics
NPI:1114142973
Name:CHARLES J ZIMMERMANN DPM
Entity Type:Organization
Organization Name:CHARLES J ZIMMERMANN DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ZIMMERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:859-236-5140
Mailing Address - Street 1:105 CITATION DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-8633
Mailing Address - Country:US
Mailing Address - Phone:859-236-5140
Mailing Address - Fax:859-236-5153
Practice Address - Street 1:105 CITATION DR
Practice Address - Street 2:SUITE D
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-8633
Practice Address - Country:US
Practice Address - Phone:859-236-5140
Practice Address - Fax:859-236-5153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY206213E00000X
KY00206332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000066482OtherANTHEM
KY80002066Medicaid
KY1183200001Medicare NSC
KY480018146Medicare PIN
KY2011401Medicare PIN