Provider Demographics
NPI:1912181298
Name:ZUCKERMAN, JODI DAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:DAWN
Last Name:ZUCKERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1160 PARK AVE W STE 4N
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2271
Mailing Address - Country:US
Mailing Address - Phone:847-433-5555
Mailing Address - Fax:847-433-9148
Practice Address - Street 1:1160 PARK AVE W STE 4N
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2271
Practice Address - Country:US
Practice Address - Phone:847-433-5555
Practice Address - Fax:847-433-9148
Is Sole Proprietor?:No
Enumeration Date:2007-12-22
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.122071207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology