Provider Demographics
NPI:1871601302
Name:ZIMMERMAN, MICHAEL S (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
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 1:2700 CRIMSON CANYON DR
Mailing Address - Street 2:STE 180
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0802
Mailing Address - Country:US
Mailing Address - Phone:702-562-2420
Mailing Address - Fax:702-562-3202
Practice Address - Street 1:2136 E DESERT INN RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-0802
Practice Address - Country:US
Practice Address - Phone:702-562-2420
Practice Address - Fax:702-562-3202
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7539174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019790Medicaid
NVCH1004OtherRAILROAD MEDICARE
NVVWQBDL03Medicare ID - Type Unspecified