Healthcare Provider Details

I. General information

NPI: 1932580883
Provider Name (Legal Business Name): HALEY ZIMMER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MICHIGAN ST NE #2100
GRAND RAPIDS MI
49503-2515
US

IV. Provider business mailing address

4285 PARKWAY PLACE DR SW
GRANDVILLE MI
49418-2385
US

V. Phone/Fax

Practice location:
  • Phone: 616-391-3777
  • Fax:
Mailing address:
  • Phone: 616-252-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301107547
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301107547
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: