Healthcare Provider Details

I. General information

NPI: 1114142973
Provider Name (Legal Business Name): CHARLES J ZIMMERMANN DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 CITATION DR SUITE D
DANVILLE KY
40422-8633
US

IV. Provider business mailing address

105 CITATION DR SUITE D
DANVILLE KY
40422-8633
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-5140
  • Fax: 859-236-5153
Mailing address:
  • Phone: 859-236-5140
  • Fax: 859-236-5153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberKY206
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00206
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number00206
License Number StateKY

VIII. Authorized Official

Name: DR. CHARLES JOHN ZIMMERMANN
Title or Position: PHYSICIAN
Credential: DPM
Phone: 859-236-5140