1215076153 NPI number — ELIZABETH (BETH) T ZIMMERMANN APN

Table of content: ELIZABETH (BETH) T ZIMMERMANN APN (NPI 1215076153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215076153 NPI number — ELIZABETH (BETH) T ZIMMERMANN APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIMMERMANN
Provider First Name:
ELIZABETH (BETH)
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZIMMERMANN
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
PAULINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1215076153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
360 E RANDOLPH ST
Provider Second Line Business Mailing Address:
APT. #407
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60601-5069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-519-1739
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5839 SO. MARYLAND AVE.
Provider Second Line Business Practice Location Address:
MC4062-UCCH
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-702-6175
Provider Business Practice Location Address Fax Number:
773-702-1192
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SC0200X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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