Provider Demographics
NPI:1144524729
Name:DAVID ZUKKOOR MD PC
Entity type:Organization
Organization Name:DAVID ZUKKOOR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAMIR
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ZUKKOOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-851-0500
Mailing Address - Street 1:30000 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-4900
Mailing Address - Country:US
Mailing Address - Phone:248-851-0500
Mailing Address - Fax:
Practice Address - Street 1:30000 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-4900
Practice Address - Country:US
Practice Address - Phone:248-851-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2011-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046395207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty