Individual
RAYMOND ZIMMERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8777 BROADWAY, SUITE A, MERRILLVILLE, IN 46410-6693
(219) 756-0960
(219) 756-0961
Mailing address
8777 BROADWAY, SUITE A, MERRILLVILLE, IN 46410-6693
(219) 756-0960
(219) 756-0961
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01035397A
IN
207Q00000X
Family Medicine Physician
036-081831
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0222075
BLUE CROSS GROUP NUMBER
IL
05
—
036081831
—
IL
05
—
200152060
—
IN
01
—
363149833
TAX IDENTIFICATION NUMBER
IL
01
—
3631498336019001
CDPG HFS PAYEE ID
IL
01
—
P00700171
RR MEDICARE
IL
Enumeration date
05/02/2006
Last updated
01/08/2013
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