Basic Information
| Provider Information | |||||||||
| NPI: | 1891711370 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIMMERMAN | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 748 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CHEBOYGAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497212220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316277118 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 740 S MAIN ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | CHEBOYGAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497212220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316277118 | ||||||||
| FaxNumber: | 2316271838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 02/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101009396 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0151600485 | 01 | MI | INDIVIDUAL BLUE CROSS | OTHER | 700A610010 | 01 | MI | GROUP BLUE CROSS | OTHER | 2846906 | 05 | MI | MEDICAID |