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NPI Code Detail

MEDICARE: DAVID CZUKERBERG MD

MEDICARE: DAVID CZUKERBERG MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician036097429IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578515839
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID CZUKERBERG MD
Provider Business Mailing Address
First Line : 2160 S 1ST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 312-902-3369
Fax Number : 312-902-3369
Provider Business Practice Location Address
First Line : 3249 S OAK PARK AVE
Second Line : MACNEAL HOSPITAL
City : BERWYN
State : IL
Zip : 60402-0715
Country : US
Telephone Number : 708-783-3004
Fax Number : 708-783-3489
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 01/14/2021

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