Provider Demographics
NPI:1811148281
Name:ZUCKER, MIRIAM S (MD)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:S
Last Name:ZUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 ELDER AVE
Mailing Address - Street 2:
Mailing Address - City:NICHOLS
Mailing Address - State:IA
Mailing Address - Zip Code:52766-9564
Mailing Address - Country:US
Mailing Address - Phone:319-723-4579
Mailing Address - Fax:
Practice Address - Street 1:1960 ELDER AVE
Practice Address - Street 2:
Practice Address - City:NICHOLS
Practice Address - State:IA
Practice Address - Zip Code:52766-9564
Practice Address - Country:US
Practice Address - Phone:319-723-4579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29484208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics