Basic Information
| Provider Information | |||||||||
| NPI: | 1588734818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIMMERS | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 FOXFIELD RD | ||||||||
| Address2: | |||||||||
| City: | ST CHARLES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601745799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302083200 | ||||||||
| FaxNumber: | 6302083201 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 FOXFIELD RD | ||||||||
| Address2: | |||||||||
| City: | ST CHARLES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601745799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302083200 | ||||||||
| FaxNumber: | 6302083201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 12/02/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036-096347 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01157959 | 01 | IL | MEDICARE RAIL ROAD PTAN (INDIVIDUAL) | OTHER | 920540 | 01 | IL | MEDICARE PTAN (GROUP) | OTHER | CA4748 | 01 | IL | MEDICARE RAIL ROAD PTAN (GROUP) | OTHER | 110154484 | 01 | IL | RAILROAD MEDICARE | OTHER | 920540017 | 01 | IL | MEDICARE PTAN (INDIVIDUAL) | OTHER | 036096347 | 05 | IL | MEDICAID |