Provider Demographics
NPI:1730105164
Name:ZIMDAHL, STEPHEN J (DPM)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:ZIMDAHL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 STATION ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-2052
Mailing Address - Country:US
Mailing Address - Phone:412-221-2241
Mailing Address - Fax:412-221-2243
Practice Address - Street 1:510 STATION ST
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2052
Practice Address - Country:US
Practice Address - Phone:412-221-2241
Practice Address - Fax:412-221-2243
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001780L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist