Provider Demographics
NPI:1508093428
Name:ZUCKERMAN, JACK MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:MATTHEW
Last Name:ZUCKERMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1221 SIXTH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2359
Mailing Address - Country:US
Mailing Address - Phone:231-935-0322
Mailing Address - Fax:231-935-0334
Practice Address - Street 1:1221 SIXTH ST STE 100
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2359
Practice Address - Country:US
Practice Address - Phone:231-935-0322
Practice Address - Fax:231-935-0334
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2016-02247208800000X
VA0101248101208800000X
MI4301503904208800000X
CA137309208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology