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General NPI Number Information
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NPI Number | 1740774751
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Entity Type | Individual
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Provider Name | TYLER JAMES ZIMMERMANN DPM
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Gender | Male
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 37595 7 MILE RD STE 370
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City | LIVONIA
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State | MI
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Zip | 48152-1003
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Country | US
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Telephone | 734-542-9305
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Fax |
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Provider Business Mailing Address
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Address Line | 1974 RIDGEMONT RD
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City | GROSSE POINTE WOODS
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State | MI
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Zip | 48236-1336
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Country | US
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Telephone | 701-595-1863
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901400397
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License Number State | MI
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