Provider Demographics
NPI:1588734818
Name:ZIMMERS, LORI A (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:ZIMMERS
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 1:2900 FOXFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5799
Mailing Address - Country:US
Mailing Address - Phone:630-208-3200
Mailing Address - Fax:630-208-3201
Practice Address - Street 1:2900 FOXFIELD RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5799
Practice Address - Country:US
Practice Address - Phone:630-208-3200
Practice Address - Fax:630-208-3201
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-096347207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01157959OtherMEDICARE RAIL ROAD PTAN (INDIVIDUAL)
IL920540OtherMEDICARE PTAN (GROUP)
ILCA4748OtherMEDICARE RAIL ROAD PTAN (GROUP)
IL110154484OtherRAILROAD MEDICARE
IL920540017OtherMEDICARE PTAN (INDIVIDUAL)
IL036096347Medicaid
IL920540017OtherMEDICARE PTAN (INDIVIDUAL)
ILP01157959OtherMEDICARE RAIL ROAD PTAN (INDIVIDUAL)