Healthcare Provider Details

I. General information

NPI: 1205866480
Provider Name (Legal Business Name): RAHMON ZUCKERMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 N MACOMB ST
MONROE MI
48162
US

IV. Provider business mailing address

PO BOX 964
MONROE MI
48161-0964
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-4435
  • Fax:
Mailing address:
  • Phone: 616-975-1845
  • Fax: 616-975-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number5101010695
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: