Healthcare Provider Details

I. General information

NPI: 1033289541
Provider Name (Legal Business Name): STEVEN JOEL ZUCKERMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28050 GRAND RIVER AVE
FARMINGTON HILLS MI
48336-5919
US

IV. Provider business mailing address

28050 GRAND RIVER AVE
FARMINGTON HILLS MI
48336-5919
US

V. Phone/Fax

Practice location:
  • Phone: 248-471-8371
  • Fax:
Mailing address:
  • Phone: 248-471-8371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5101006670
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: