Provider Demographics
NPI:1851350318
Name:ZIMMERMAN, RENA BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:RENA
Middle Name:BETH
Last Name:ZIMMERMAN
Suffix:
Gender:F
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:PO BOX 734138
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-4138
Mailing Address - Country:US
Mailing Address - Phone:815-344-8000
Mailing Address - Fax:815-759-4075
Practice Address - Street 1:4305 W MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8425
Practice Address - Country:US
Practice Address - Phone:815-344-8000
Practice Address - Fax:815-759-4075
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053193Z2085R0001X
NDPT205252085R0001X
IL0360711962085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0671849Medicaid
G8889434OtherMEDICARE
P000813208OtherMEDICARE RAILROAD
WA2004174Medicaid
P000813208OtherMEDICARE RAILROAD
OHA17733Medicare UPIN
OH0887521Medicare PIN