Healthcare Provider Details

I. General information

NPI: 1609308857
Provider Name (Legal Business Name): NICHOLE ZUCCARINI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST UHC 9C
DETROIT MI
48201-2153
US

IV. Provider business mailing address

546 W BRIAR PL APT 3A
CHICAGO IL
60657-4688
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-6035
  • Fax:
Mailing address:
  • Phone: 303-818-2978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME152854
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: