Healthcare Provider Details

I. General information

NPI: 1174618300
Provider Name (Legal Business Name): LEONARD J ZUCKERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 RAMBLEWOOD DR
EAST LANSING MI
48823-6367
US

IV. Provider business mailing address

2175 COOLIDGE RD
EAST LANSING MI
48823-1379
US

V. Phone/Fax

Practice location:
  • Phone: 517-324-3700
  • Fax: 517-324-4589
Mailing address:
  • Phone: 517-324-3705
  • Fax: 517-324-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberLZ038612
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: