Provider Demographics
NPI:1619958071
Name:ZUCKER, TERRY SCOTT (DPM)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:SCOTT
Last Name:ZUCKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 JANET DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1158
Mailing Address - Country:US
Mailing Address - Phone:847-509-1320
Mailing Address - Fax:847-509-1320
Practice Address - Street 1:2224 JANET DR
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1158
Practice Address - Country:US
Practice Address - Phone:847-509-1320
Practice Address - Fax:847-509-1320
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT39087Medicare UPIN
IL215016Medicare PIN