Active NPI
Kolleen L Zimmermann, M.D.
- Dermatology Physician
- Green Bay, WI
National Provider Identifier
1619981164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 38042-020
- Practice address
- 715 Superior Rd Ste 120
Green Bay, WI 54311-7595 - Phone
- (920) 406-9803
- Fax
- (920) 406-9934
- NPI assigned
- Jul 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 38042-020 | WI | Primary |
Addresses
Primary practice location
715 Superior Rd Ste 120
Green Bay, WI 54311-7595
Mailing address
2461 Holmgren Way
Green Bay, WI 54304-5224
Phone (920) 496-4700
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 070016223 | Other | WI | RAILROAD MEDICARE |
| 32561400 | Medicaid | WI |
Other names 1
- Dr. Kolleen L Kruzan
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38042-020 | WI | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Healthcare SC | Dermatology | Past | Accepting new patients |
| Aurora Advanced Healthcare, Inc. | Dermatology | Past | Accepting new patients |
| Dermatology Clinic S.C. | Dermatology | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dermatology Physician
- Green Bay, WI
- NPI 1427079516
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531785600000",
"number": "1619981164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2461 HOLMGREN WAY",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543045224",
"telephone_number": "920-496-4700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "715 SUPERIOR RD STE 120",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543117595",
"telephone_number": "920-406-9803",
"fax_number": "920-406-9934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZIMMERMANN",
"first_name": "KOLLEEN",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-28",
"last_updated": "2018-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "WI",
"license": "38042-020",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "070016223",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32561400",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KOLLEEN",
"last_name": "KRUZAN",
"middle_name": "L",
"prefix": "DR.",
"credential": "M.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.