Provider Demographics
NPI:1104933159
Name:ZUKOWSKY, MICHAEAL M (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEAL
Middle Name:M
Last Name:ZUKOWSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 MEADOWS RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2346
Mailing Address - Country:US
Mailing Address - Phone:561-392-4107
Mailing Address - Fax:561-393-7130
Practice Address - Street 1:801 MEADOWS RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2346
Practice Address - Country:US
Practice Address - Phone:561-392-4107
Practice Address - Fax:561-393-7130
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38927207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257546900Medicaid
FLB19178Medicare UPIN
FL257546900Medicaid