Provider Demographics
NPI:1881696623
Name:ZUCKER, ALAN J (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:J
Last Name:ZUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 E JANATA BLVD
Mailing Address - Street 2:STE 130
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5317
Mailing Address - Country:US
Mailing Address - Phone:630-932-2055
Mailing Address - Fax:630-932-2059
Practice Address - Street 1:246 E JANATA BLVD
Practice Address - Street 2:STE 130
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5317
Practice Address - Country:US
Practice Address - Phone:630-932-2055
Practice Address - Fax:630-932-2059
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059644174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL694720Medicare ID - Type Unspecified
ILD15043Medicare UPIN