Provider Demographics
NPI:1558476549
Name:MICHAEL A ZIMMER M D P L C
Entity Type:Organization
Organization Name:MICHAEL A ZIMMER M D P L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACP
Authorized Official - Phone:727-820-7800
Mailing Address - Street 1:509 JACKSON ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1477
Mailing Address - Country:US
Mailing Address - Phone:727-820-7800
Mailing Address - Fax:727-820-7801
Practice Address - Street 1:509 JACKSON ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1477
Practice Address - Country:US
Practice Address - Phone:727-820-7800
Practice Address - Fax:727-820-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3418Medicare ID - Type Unspecified
FLG24092Medicare UPIN