Provider Demographics
NPI:1275575821
Name:ZIMMER, WILLIAM R (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:ZIMMER
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:PO BOX 1977
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62705-1977
Mailing Address - Country:US
Mailing Address - Phone:217-544-6464
Mailing Address - Fax:217-757-6021
Practice Address - Street 1:301 N 8TH ST
Practice Address - Street 2:STE 1B201
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-1041
Practice Address - Country:US
Practice Address - Phone:217-535-3799
Practice Address - Fax:217-525-5685
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0840046327OtherBC/BS
IL107053OtherHEALTHLINK
IL51985OtherPERSONAL CARE
IL1720ZOtherCATIPILLAR
IL008867OtherHEALTH ALLIANCE
ILK41270Medicare PIN
ILD14115Medicare UPIN
IL008867OtherHEALTH ALLIANCE