Provider Demographics
NPI:1851455125
Name:ZUCKERBERG, ERIK DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:DAVID
Last Name:ZUCKERBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 S LAPEER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1467
Mailing Address - Country:US
Mailing Address - Phone:248-693-3551
Mailing Address - Fax:248-693-4643
Practice Address - Street 1:1455 S LAPEER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1467
Practice Address - Country:US
Practice Address - Phone:248-693-3551
Practice Address - Fax:248-693-4643
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0106364922OtherBCN
MI5146564OtherAETNA
MI080141910OtherRAILROAD MEDICARE
MI0106329252OtherBCBS BCN
MI0106364922OtherBCBS
MIC6585OtherMCARE
MIG38771OtherHAP
MIN84830006Medicare PIN
MIG38771Medicare UPIN