Provider Demographics
NPI:1730178971
Name:ZUKOWSKI, MARK LAWRENCE (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:LAWRENCE
Last Name:ZUKOWSKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2217 MIRAMAR LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4692
Mailing Address - Country:US
Mailing Address - Phone:847-478-8246
Mailing Address - Fax:847-478-0456
Practice Address - Street 1:3612 LAKE AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1000
Practice Address - Country:US
Practice Address - Phone:847-853-8869
Practice Address - Fax:847-853-8870
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
431070Medicare ID - Type Unspecified
G67948Medicare UPIN