Healthcare Provider Details

I. General information

NPI: 1831135771
Provider Name (Legal Business Name): MIKKO B ZUCHNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/07/2023
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 PINE RIDGE BLVD
WAUSAU WI
54401-4123
US

IV. Provider business mailing address

156169 RESTLAWN RD
WAUSAU WI
54403-5544
US

V. Phone/Fax

Practice location:
  • Phone: 715-845-5505
  • Fax:
Mailing address:
  • Phone: 715-551-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number52406
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: