Basic Information
| Provider Information | |||||||||
| NPI: | 1174769939 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIMMERMAN | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13900 W NATIONAL AVE | ||||||||
| Address2: | |||||||||
| City: | NEW BERLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531519515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2629284500 | ||||||||
| FaxNumber: | 2629284550 | ||||||||
| Practice Location | |||||||||
| Address1: | 13900 W NATIONAL AVE | ||||||||
| Address2: | |||||||||
| City: | NEW BERLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531519515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2629284500 | ||||||||
| FaxNumber: | 2629284550 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 207Q00000X | 105193 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MT192598 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 66873 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.