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NPI Code Detail

MEDICARE: DR. MATTHEW JACOB ZIMMIE M.D.

MEDICARE: DR. MATTHEW JACOB ZIMMIE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician4301078497MI

General Provider Information

NPI Number : 1235109257
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW JACOB ZIMMIE M.D.
Provider Business Mailing Address
First Line : 3600 VISTA AVENUE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-2540
Country : US
Telephone Number : 248-990-4287
Fax Number :
Provider Business Practice Location Address
First Line : 3600 VISTA AVENUE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-2540
Country : US
Telephone Number : 248-990-4287
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2006
Last Update Date : 01/28/2021

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