Provider Demographics
NPI:1083663538
Name:ZUCKER, MICHELE L (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:ZUCKER
Suffix:
Gender:F
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:PO BOX 131747
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92013-1747
Mailing Address - Country:US
Mailing Address - Phone:193-506-2906
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:2659 STATE ST STE 100
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1627
Practice Address - Country:US
Practice Address - Phone:619-350-6290
Practice Address - Fax:619-436-4739
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.084839208000000X, 2080A0000X
NY312011-012080A0000X
TXT40952080A0000X
WAMD611819702080A0000X
CODR.00673842080A0000X
PAMD4325422080A0000X
CA036.1494302080A0000X
IL036.1494302080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2530069Medicaid
OH2530069Medicaid