Provider Demographics
NPI:1134112352
Name:ZIMMERMAN, JANIS E (MD)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:E
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 JEFFERSON AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43624-1120
Mailing Address - Country:US
Mailing Address - Phone:419-251-2673
Mailing Address - Fax:419-251-0916
Practice Address - Street 1:1500 N SUPERIOR ST
Practice Address - Street 2:SUITE 310
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-2157
Practice Address - Country:US
Practice Address - Phone:419-729-6400
Practice Address - Fax:419-729-6478
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2050695Medicaid
OH2050695Medicaid
OHZI0819566Medicare PIN