Healthcare Provider Details

I. General information

NPI: 1154513356
Provider Name (Legal Business Name): RANDY ZIMMERMAN M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27750 W HIGHWAY 22 SUITE 120
BARRINGTON IL
60010-2379
US

IV. Provider business mailing address

27750 W HIGHWAY 22 SUITE 120
BARRINGTON IL
60010-2379
US

V. Phone/Fax

Practice location:
  • Phone: 847-277-0500
  • Fax: 847-277-0505
Mailing address:
  • Phone: 847-277-0500
  • Fax: 847-277-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. RANDY R ZIMMERMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-277-0500