Provider Demographics
NPI:1245248145
Name:ZIMMERMANN, CHARLES J (DPM)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:ZIMMERMANN
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:3080 HARRODSBURG RD
Mailing Address - Street 2:STE 225
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2774
Mailing Address - Country:US
Mailing Address - Phone:859-296-4272
Mailing Address - Fax:859-296-9645
Practice Address - Street 1:3080 HARRODSBURG RD
Practice Address - Street 2:STE 225
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2774
Practice Address - Country:US
Practice Address - Phone:859-296-4272
Practice Address - Fax:859-296-9645
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY00206213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY480031505OtherRAILROAD MEDICARE
KY80002066Medicaid
KY000000041863OtherANTHEM BCBS
U32235Medicare UPIN
KY80002066Medicaid