Provider Demographics
NPI:1144215484
Name:ZUKOWSKI, CHRIS M (MD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:M
Last Name:ZUKOWSKI
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 1:4855 S MOORLAND RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-7401
Mailing Address - Country:US
Mailing Address - Phone:414-425-5660
Mailing Address - Fax:414-425-9803
Practice Address - Street 1:4855 S MOORLAND RD
Practice Address - Street 2:SUITE 150
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-7401
Practice Address - Country:US
Practice Address - Phone:414-425-5660
Practice Address - Fax:414-425-9803
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35074208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31995800Medicaid
WI01750Medicare ID - Type Unspecified
WIF76748Medicare UPIN