Healthcare Provider Details

I. General information

NPI: 1558476549
Provider Name (Legal Business Name): MICHAEL A ZIMMER M D P L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 JACKSON ST N
ST PETERSBURG FL
33705-1477
US

IV. Provider business mailing address

509 JACKSON ST N
ST PETERSBURG FL
33705-1477
US

V. Phone/Fax

Practice location:
  • Phone: 727-820-7800
  • Fax: 727-820-7801
Mailing address:
  • Phone: 727-820-7800
  • Fax: 727-820-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL A ZIMMER
Title or Position: OWNER
Credential: MD FACP
Phone: 727-820-7800