Healthcare Provider Details

I. General information

NPI: 1568414910
Provider Name (Legal Business Name): RONALD ANDREW RIMMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANDY RIMMER M.D.

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4303 MICHIGAN AVE
MANITOWOC WI
54220-3066
US

IV. Provider business mailing address

PO BOX 2290
MANITOWOC WI
54221-2290
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-2436
  • Fax:
Mailing address:
  • Phone: 920-320-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number00024621
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number07070683A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: