Provider Demographics
NPI:1518909647
Name:ZIMMERMAN, MICHAEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
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 1:6300 LA CALMA DRIVE SUITE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752
Mailing Address - Country:US
Mailing Address - Phone:512-452-8533
Mailing Address - Fax:512-685-0612
Practice Address - Street 1:6300 LA CALMA DR STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3825
Practice Address - Country:US
Practice Address - Phone:512-452-8533
Practice Address - Fax:512-685-0612
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-105559207P00000X
WI44719-020207P00000X
IN01054617A207P00000X
TXP5765207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00030482OtherMEDICARE RAILROAD
WI34382800Medicaid
IL930123623OtherMEDICARE RAILROAD
ILP00043246OtherMEDICARE RAILROAD
WIP00030482OtherMEDICARE RAILROAD
WI0102-68655Medicare ID - Type Unspecified
WI34382800Medicaid
ILP00043246OtherMEDICARE RAILROAD
IL930123623OtherMEDICARE RAILROAD