Provider Demographics
NPI:1427044171
Name:ZIMMERMAN, RANDY RAY (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:RAY
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 1:27750 W HIGHWAY 22
Mailing Address - Street 2:STE 120
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2379
Mailing Address - Country:US
Mailing Address - Phone:847-277-0500
Mailing Address - Fax:847-277-0505
Practice Address - Street 1:27750 W HIGHWAY 22
Practice Address - Street 2:STE 120
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2379
Practice Address - Country:US
Practice Address - Phone:847-277-0500
Practice Address - Fax:847-277-0505
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4921797OtherBCBS
IL728931Medicare PIN
ILD15512Medicare UPIN