Provider Demographics
NPI:1154396786
Name:ZIMMERMAN, JULIE G (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:G
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-767-1900
Mailing Address - Fax:
Practice Address - Street 1:576 APOLLO DR
Practice Address - Street 2:MAIL STOP 39603A
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-3004
Practice Address - Country:US
Practice Address - Phone:651-784-1611
Practice Address - Fax:651-784-6093
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN36447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN911027500Medicaid
MN911027500Medicaid
080010725Medicare ID - Type Unspecified