Healthcare Provider Details

I. General information

NPI: 1619243607
Provider Name (Legal Business Name): MATTHEW A ZUCKERMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2012
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S YORK ST STE 2000
ELMHURST IL
60126-5634
US

IV. Provider business mailing address

4201 WINFIELD RD FL 4
WARRENVILLE IL
60555-4025
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-9002
  • Fax: 331-221-2749
Mailing address:
  • Phone: 331-221-6377
  • Fax: 331-221-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036140325
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: