Provider Demographics
NPI:1225362759
Name:ROBERT M ZIMMERMAN MD PC
Entity Type:Organization
Organization Name:ROBERT M ZIMMERMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-769-4644
Mailing Address - Street 1:555 E WILLIAM ST APT 22G
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2427
Mailing Address - Country:US
Mailing Address - Phone:734-769-4644
Mailing Address - Fax:
Practice Address - Street 1:555 E WILLIAM ST APT 22G
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2427
Practice Address - Country:US
Practice Address - Phone:734-769-4644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT M ZIMMERMAN MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301029272261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1295793701Medicare UPIN
MI0812051Medicare PIN