Provider Demographics
NPI:1871525055
Name:INTERNAL MEDICINE CONSULTANTS OF NORTHWEST OHIO LTD
Entity type:Organization
Organization Name:INTERNAL MEDICINE CONSULTANTS OF NORTHWEST OHIO LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-874-9096
Mailing Address - Street 1:580 CRAIG DR STE 8
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1776
Mailing Address - Country:US
Mailing Address - Phone:419-861-5430
Mailing Address - Fax:419-861-5430
Practice Address - Street 1:580 CRAIG DR STE 8
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1776
Practice Address - Country:US
Practice Address - Phone:419-861-5430
Practice Address - Fax:419-861-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2093158Medicaid
OHCH3197OtherRAILROAD MEDICARE
OH000000169296OtherANTHEM
OH2093158Medicaid
OH9310861Medicare PIN