Healthcare Provider Details

I. General information

NPI: 1194749218
Provider Name (Legal Business Name): PATRICK ZIMMERMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 VANDALIA ST SUITE 100
COLLINSVILLE IL
62234-4061
US

IV. Provider business mailing address

6810 STATE ROUTE 162 BOX 215
MARYVILLE IL
62062
US

V. Phone/Fax

Practice location:
  • Phone: 618-344-0090
  • Fax: 618-344-4371
Mailing address:
  • Phone: 618-391-6495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number036059275
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number036059275
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036059275
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: