Healthcare Provider Details

I. General information

NPI: 1831551332
Provider Name (Legal Business Name): MELISSA BROOK ZIMMERMAN MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA JOY BROOK MD, MPH

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S WAUKEGAN RD STE 100&200
DEERFIELD IL
60015-5239
US

IV. Provider business mailing address

840 S WOOD ST
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-7994
  • Fax: 847-535-8210
Mailing address:
  • Phone: 312-996-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.147330
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.147330
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: