Provider Demographics
NPI:1497736383
Name:ZUCKER, KEVIN BRUCE (DPM)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BRUCE
Last Name:ZUCKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 ARROWWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1039
Mailing Address - Country:US
Mailing Address - Phone:847-778-0573
Mailing Address - Fax:847-509-1320
Practice Address - Street 1:244 ARROWWOOD DR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1039
Practice Address - Country:US
Practice Address - Phone:847-778-0573
Practice Address - Fax:847-509-1320
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003702213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003702Medicaid
ILL09261Medicare UPIN
ILK35579Medicare ID - Type UnspecifiedPODIATRIST
IL921880Medicare ID - Type Unspecified
IL214786Medicare ID - Type Unspecified