Provider Demographics
NPI:1265815187
Name:ZIMMERMAN, ZACHARY ADAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:ADAM
Last Name:ZIMMERMAN
Suffix:
Gender:M
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:BELOIT HEALTH SYSTEM
Mailing Address - Street 2:1905 E. HUEBBE PARKWAY
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2400
Mailing Address - Fax:608-363-7376
Practice Address - Street 1:BELOIT CLINIC
Practice Address - Street 2:1905 E HUEBBE PARKWAY
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1842
Practice Address - Country:US
Practice Address - Phone:608-364-2400
Practice Address - Fax:608-363-7376
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7590207Y00000X
IL036-151049207Y00000X, 207YS0123X
IL036151049207YS0123X
WI75795-20207YS0123X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100175684Medicaid
FL7590OtherGEORGIA COMPOSITE MEDICAL BOARD