Healthcare Provider Details

I. General information

NPI: 1518909647
Provider Name (Legal Business Name): MICHAEL P ZIMMERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 11/17/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 LA CALMA DR STE 200
AUSTIN TX
78752-3825
US

IV. Provider business mailing address

6300 LA CALMA DRIVE SUITE 200
AUSTIN TX
78752
US

V. Phone/Fax

Practice location:
  • Phone: 512-452-8533
  • Fax: 512-685-0612
Mailing address:
  • Phone: 512-452-8533
  • Fax: 512-685-0612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-105559
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number44719-020
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01054617A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberP5765
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: