Provider Demographics
NPI:1477588564
Name:ZIMMERS, HERBERT J (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:J
Last Name:ZIMMERS
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 1:1620 E DEAN RD
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-2407
Mailing Address - Country:US
Mailing Address - Phone:414-352-3889
Mailing Address - Fax:
Practice Address - Street 1:1620 E DEAN RD
Practice Address - Street 2:
Practice Address - City:FOX POINT
Practice Address - State:WI
Practice Address - Zip Code:53217-2407
Practice Address - Country:US
Practice Address - Phone:414-352-3889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI184402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30862400Medicaid
WIP00451370OtherRR MEDICARE
WI68635-0257Medicare ID - Type Unspecified
WIB57845Medicare UPIN
WI01994-0200Medicare PIN
WIP00451370OtherRR MEDICARE
WI46236-0200Medicare PIN