Basic Information
| Provider Information | |||||||||
| NPI: | 1518909647 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIMMERMAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6300 LA CALMA DRIVE SUITE 200 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124528533 | ||||||||
| FaxNumber: | 5126850612 | ||||||||
| Practice Location | |||||||||
| Address1: | 6300 LA CALMA DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787523825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124528533 | ||||||||
| FaxNumber: | 5126850612 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 01/29/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 036-105559 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 44719-020 | WI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 01054617A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | P5765 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 930123623 | 01 | IL | MEDICARE RAILROAD | OTHER | P00043246 | 01 | IL | MEDICARE RAILROAD | OTHER | 34382800 | 05 | WI | MEDICAID | P00030482 | 01 | WI | MEDICARE RAILROAD | OTHER |