Healthcare Provider Details

I. General information

NPI: 1497736383
Provider Name (Legal Business Name): KEVIN BRUCE ZUCKER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 ARROWWOOD DR
NORTHBROOK IL
60062-1039
US

IV. Provider business mailing address

244 ARROWWOOD DR
NORTHBROOK IL
60062-1039
US

V. Phone/Fax

Practice location:
  • Phone: 847-778-0573
  • Fax: 847-509-1320
Mailing address:
  • Phone: 847-778-0573
  • Fax: 847-509-1320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016003702
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: