Healthcare Provider Details

I. General information

NPI: 1124138433
Provider Name (Legal Business Name): ANNA M ZIMMERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 N 4TH ST
TERRE HAUTE IN
47804-4002
US

IV. Provider business mailing address

221 S 6TH ST
TERRE HAUTE IN
47807-4214
US

V. Phone/Fax

Practice location:
  • Phone: 812-242-3600
  • Fax: 812-242-3620
Mailing address:
  • Phone: 812-242-3600
  • Fax: 812-242-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01032391A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: