Provider Demographics
NPI:1568414910
Name:RIMMER, RONALD ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:ANDREW
Last Name:RIMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANDY
Other - Middle Name:
Other - Last Name:RIMMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2290
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-2290
Mailing Address - Country:US
Mailing Address - Phone:920-320-4070
Mailing Address - Fax:
Practice Address - Street 1:4303 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-3066
Practice Address - Country:US
Practice Address - Phone:920-320-2436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00024621174400000X
IN07070683A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201055980Medicaid
AL009982710Medicaid
AL09137OtherBCBS
ALH59950Medicare UPIN
ALH59950Medicare ID - Type Unspecified