Provider Demographics
NPI:1750357620
Name:ZIMMERMAN, PHIL G (MD)
Entity type:Individual
Prefix:DR
First Name:PHIL
Middle Name:G
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1601 PARKVIEW AVE
Mailing Address - Street 2:S200
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1822
Mailing Address - Country:US
Mailing Address - Phone:815-395-5851
Mailing Address - Fax:815-395-8644
Practice Address - Street 1:405 CHARLES ST
Practice Address - Street 2:
Practice Address - City:MT MORRIS
Practice Address - State:IL
Practice Address - Zip Code:61054-1646
Practice Address - Country:US
Practice Address - Phone:815-734-6061
Practice Address - Fax:815-734-9021
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3360122024OtherCONTROLLED SUBSTANCE