Provider Demographics
NPI:1285837096
Name:SCOTT A ZIMMERMAN, D.P.M., LTD.
Entity Type:Organization
Organization Name:SCOTT A ZIMMERMAN, D.P.M., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-953-8088
Mailing Address - Street 1:10 E 22ND ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6108
Mailing Address - Country:US
Mailing Address - Phone:630-953-8088
Mailing Address - Fax:630-953-8094
Practice Address - Street 1:10 E 22ND ST
Practice Address - Street 2:SUITE 205
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6108
Practice Address - Country:US
Practice Address - Phone:630-953-8088
Practice Address - Fax:630-953-8094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003422213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0506240001Medicare NSC
IL215299Medicare PIN
ILT37989Medicare UPIN
IL980290Medicare PIN