Healthcare Provider Details

I. General information

NPI: 1538198304
Provider Name (Legal Business Name): CHERYL R ZUCCARO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 N LAKE DR ROOM 3603
MILWAUKEE WI
53211-4507
US

IV. Provider business mailing address

4425 N PORT WASHINGTON RD ATTN: CSMCP CLINIC CREDENTIALING
GLENDALE WI
53212-1082
US

V. Phone/Fax

Practice location:
  • Phone: 414-270-4932
  • Fax:
Mailing address:
  • Phone: 414-270-4932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32655
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: