Provider Demographics
NPI:1821539446
Name:ZUKAS, KEITH
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:ZUKAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4822 EVERHARD RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2413
Mailing Address - Country:US
Mailing Address - Phone:234-401-9248
Mailing Address - Fax:
Practice Address - Street 1:20812 SYDENHAM RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-2926
Practice Address - Country:US
Practice Address - Phone:234-401-9248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02389237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist