Healthcare Provider Details

I. General information

NPI: 1821539446
Provider Name (Legal Business Name): KEITH ZUKAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20812 SYDENHAM RD
SHAKER HEIGHTS OH
44122-2926
US

IV. Provider business mailing address

4822 EVERHARD RD NW
CANTON OH
44718-2413
US

V. Phone/Fax

Practice location:
  • Phone: 234-401-9248
  • Fax:
Mailing address:
  • Phone: 234-401-9248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number02389
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: