Provider Demographics
NPI:1316015852
Name:ZIMMERMAN, ERROL M (MD)
Entity Type:Individual
Prefix:
First Name:ERROL
Middle Name:M
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 1:2799 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-916-8144
Mailing Address - Fax:
Practice Address - Street 1:2799 WEST GRAND BLVD.
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-916-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1316015852208M00000X
MI4301056632207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
700H262220OtherBLUE CROSS-BLUE CROSS
EZ056632OtherCHAMPUS-CHAMPUS
MI306001110Medicaid
EZ056632OtherCOMMERCIAL-COMMERCIAL NUMBER
F83584Medicare UPIN
F83584Medicare UPIN