Provider Demographics
NPI:1295942969
Name:GETTELMAN, ZUKOW, KEER MD
Entity type:Organization
Organization Name:GETTELMAN, ZUKOW, KEER MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD PRES SEC
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-996-9677
Mailing Address - Street 1:5525 ETIWANDA AVE 212
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-996-9708
Mailing Address - Fax:818-996-9709
Practice Address - Street 1:5525 ETIWANDA AVE 212
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:818-996-9708
Practice Address - Fax:818-996-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG10084208000000X
CAA788096208000000X
CAA19954208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty