Basic Information
| Provider Information | |||||||||
| NPI: | 1265815187 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIMMERMAN | ||||||||
| FirstName: | ZACHARY | ||||||||
| MiddleName: | ADAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | BELOIT HEALTH SYSTEM | ||||||||
| Address2: | 1905 E. HUEBBE PARKWAY | ||||||||
| City: | BELOIT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535111842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083642293 | ||||||||
| FaxNumber: | 6083645452 | ||||||||
| Practice Location | |||||||||
| Address1: | BELOIT CLINIC | ||||||||
| Address2: | 1905 E HUEBBE PARKWAY | ||||||||
| City: | BELOIT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535111842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083642400 | ||||||||
| FaxNumber: | 6083637376 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2015 | ||||||||
| LastUpdateDate: | 08/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 7590 | GA | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 75795-20 | WI | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 036-151049 | IL | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207YS0123X | 036151049 | IL | N | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery | 207YS0123X | 036-151049 | IL | N | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery | 207YS0123X | 75795-20 | WI | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 7590 | 01 | FL | GEORGIA COMPOSITE MEDICAL BOARD | OTHER |