Provider Demographics
NPI:1619068582
Name:ZUKKOOR, NAMIR DAVID (MD)
Entity Type:Individual
Prefix:
First Name:NAMIR
Middle Name:DAVID
Last Name:ZUKKOOR
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 1:30000 ORCHARD LAKE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:248-851-0500
Mailing Address - Fax:248-851-6006
Practice Address - Street 1:30000 ORCHARD LAKE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-851-0500
Practice Address - Fax:248-851-6006
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI046395207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B47214Medicare UPIN
0637451Medicare ID - Type Unspecified
MI0M96210Medicare PIN