MEDICARE: DONALD DAVID NIMMER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	29494	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477555951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD DAVID NIMMER M.D.

Provider Business Mailing Address
First Line	:	4935 S 76TH ST STE 101
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53220-4305
Country	:	US
Telephone Number	:	414-777-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 W LOOMIS RD
Second Line	:	SUITE 130
City	:	GREENFIELD
State	:	WI
Zip	:	53220-4858
Country	:	US
Telephone Number	:	414-389-4900
Fax Number	:	414-465-4606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2005
Last Update Date	:	09/19/2022

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