1386602100 NPI number — RAYMOND ZIMMERMAN M.D.

Table of content: RAYMOND ZIMMERMAN M.D. (NPI 1386602100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386602100 NPI number — RAYMOND ZIMMERMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIMMERMAN
Provider First Name:
RAYMOND
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386602100
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8777 BROADWAY
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MERRILLVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46410-6693
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-756-0960
Provider Business Mailing Address Fax Number:
219-756-0961

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8777 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MERRILLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46410-6693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-756-0960
Provider Business Practice Location Address Fax Number:
219-756-0961
Provider Enumeration Date:
05/02/2006

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: 207Q00000X , with the licence number:  01035397A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: 036-081831 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 036081831 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200152060 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0222075 . This is a "BLUE CROSS GROUP NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 3631498336019001 . This is a "CDPG HFS PAYEE ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00700171 . This is a "RR MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 363149833 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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