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General NPI Number Information
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NPI Number | 1821539446
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Entity Type | Individual
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Provider Name | KEITH ZUKAS
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Gender | Male
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Dates
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Enumeration Date | 03/15/2017
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 20812 SYDENHAM RD
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-2926
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Country | US
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Telephone | 234-401-9248
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Fax |
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Provider Business Mailing Address
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Address Line | 4822 EVERHARD RD NW
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City | CANTON
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State | OH
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Zip | 44718-2413
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Country | US
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Telephone | 234-401-9248
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 02389
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License Number State | OH
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