Individual
DR. MARK W CIMMERER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7339
(616) 361-5828
Mailing address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7339
(616) 361-5828
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301406940
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200000001748
PHP OF MIDMICHIGAN
MI
05
—
2824810
—
MI
05
—
2829389
—
MI
05
—
2832974
—
MI
01
—
300023174
RAILROAD MEDICARE
MI
01
—
300023192
RAILROAD MEDICARE
MI
Enumeration date
10/23/2006
Last updated
05/08/2009
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