Provider Demographics
NPI:1750367249
Name:ZIMMERMAN, ZANE WESLEY (DO)
Entity type:Individual
Prefix:DR
First Name:ZANE
Middle Name:WESLEY
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-9805
Mailing Address - Country:US
Mailing Address - Phone:419-592-4015
Mailing Address - Fax:
Practice Address - Street 1:1600 E RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-9399
Practice Address - Country:US
Practice Address - Phone:419-592-4015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0536130207Q00000X
HIDOS-1307207Q00000X
OH34.008053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH015180OtherMEDICARE
KS200973000AMedicaid
OH2405687Medicaid
KS200973000AMedicaid
OH2405687Medicaid