Provider Demographics
NPI:1285269399
Name:ZIMMERMAN, TODD ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ANDREW
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-570-2114
Mailing Address - Fax:847-570-1223
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1700
Practice Address - Country:US
Practice Address - Phone:847-570-2114
Practice Address - Fax:847-570-1223
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2024-08-22
Deactivation Date:2021-04-30
Deactivation Code:
Reactivation Date:2021-05-24
Provider Licenses
StateLicense IDTaxonomies
IL036169174207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4351047594OtherPHYSICIAN EDUCATION LIMITED LISENSE