Provider Demographics
NPI:1063418242
Name:ZIMET, SUSAN (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ZIMET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E MAIN ST
Mailing Address - Street 2:STE 201
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-1778
Mailing Address - Country:US
Mailing Address - Phone:970-544-1131
Mailing Address - Fax:970-544-1195
Practice Address - Street 1:600 E MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1991
Practice Address - Country:US
Practice Address - Phone:970-544-1131
Practice Address - Fax:844-384-5032
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01308642Medicaid
COE88280Medicare UPIN
CO01308642Medicaid