Healthcare Provider Details

I. General information

NPI: 1619958071
Provider Name (Legal Business Name): TERRY SCOTT ZUCKER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 JANET DR
GLENVIEW IL
60026-1158
US

IV. Provider business mailing address

2224 JANET DR
GLENVIEW IL
60026-1158
US

V. Phone/Fax

Practice location:
  • Phone: 847-509-1320
  • Fax: 847-509-1320
Mailing address:
  • Phone: 847-509-1320
  • Fax: 847-509-1320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: