Provider Demographics
NPI:1215910245
Name:ZIMMERMAN, TODD LEWIS (DO)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:LEWIS
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:MISS
Other - First Name:ANNE
Other - Middle Name:M
Other - Last Name:MOLITERNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 87904
Mailing Address - Street 2:DEPT 2049
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-7904
Mailing Address - Country:US
Mailing Address - Phone:630-734-0200
Mailing Address - Fax:630-734-1560
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VLG
Practice Address - State:IL
Practice Address - Zip Code:60007-3311
Practice Address - Country:US
Practice Address - Phone:847-437-5500
Practice Address - Fax:630-734-1560
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097110207P00000X
NVDO2300208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
K20826Medicare ID - Type Unspecified
H82421Medicare UPIN