Provider Demographics
NPI:1699118224
Name:ZIMMERMAN, MICHAEL RYAN (DPM)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RYAN
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 MERCY RD
Mailing Address - Street 2:STE 2000
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2323
Mailing Address - Country:US
Mailing Address - Phone:712-310-6223
Mailing Address - Fax:
Practice Address - Street 1:300 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-1514
Practice Address - Country:US
Practice Address - Phone:402-336-2611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-13
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA092598213ES0103X
NE360213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery