Provider Demographics
NPI:1366505109
Name:KEVIN B ZUCKER DPM PC
Entity Type:Organization
Organization Name:KEVIN B ZUCKER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ZUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-821-0743
Mailing Address - Street 1:1311 MADISON DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6827
Mailing Address - Country:US
Mailing Address - Phone:847-821-0743
Mailing Address - Fax:847-821-1421
Practice Address - Street 1:1311 MADISON DR
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6827
Practice Address - Country:US
Practice Address - Phone:847-821-0743
Practice Address - Fax:847-821-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214786Medicare ID - Type Unspecified
ILK35579Medicare ID - Type Unspecified
ILT37837Medicare UPIN