Healthcare Provider Details

I. General information

NPI: 1477588564
Provider Name (Legal Business Name): HERBERT J. ZIMMERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 E DEAN RD
FOX POINT WI
53217-2407
US

IV. Provider business mailing address

1620 E DEAN RD
FOX POINT WI
53217-2407
US

V. Phone/Fax

Practice location:
  • Phone: 414-352-3889
  • Fax:
Mailing address:
  • Phone: 414-352-3889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number18440
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: