Provider Demographics
NPI:1922267186
Name:ZIPSER, MIMI (MD)
Entity Type:Individual
Prefix:
First Name:MIMI
Middle Name:
Last Name:ZIPSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIMI
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:475 S DOBSON RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:475 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5605
Practice Address - Country:US
Practice Address - Phone:480-728-3753
Practice Address - Fax:480-728-3305
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40155207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8543118Medicaid
OR500611513Medicaid
WAG8881295Medicare PIN