Individual provider Active NPI

Michele L Zucker, M.D.

  • Pediatric Adolescent Medicine Physician
  • Carlsbad, CA
National Provider Identifier
1083663538
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
036.149430 Issued in IL
Practice address
2659 State St Ste 100
Carlsbad, CA 92008-1627
Phone
(619) 350-6290
Fax
(619) 436-4739
NPI assigned
May 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 35.084839 OH
Pediatric Adolescent Medicine Physician 2080A0000X 312011-01 NY
Pediatric Adolescent Medicine Physician 2080A0000X T4095 TX
Pediatric Adolescent Medicine Physician 2080A0000X MD61181970 WA
Pediatric Adolescent Medicine Physician 2080A0000X DR.0067384 CO
Pediatric Adolescent Medicine Physician 2080A0000X MD432542 PA
Pediatric Adolescent Medicine Physician 2080A0000X 35.084839 OH
Pediatric Adolescent Medicine Physician 2080A0000X 036.149430 CA
Pediatric Adolescent Medicine Physician 2080A0000X 036.149430 IL Primary

Addresses

Primary practice location

2659 State St Ste 100
Carlsbad, CA 92008-1627

Mailing address

PO Box 131747
Carlsbad, CA 92013-1747
Phone (193) 506-2906

Other identifiers 1

IdentifierTypeStateIssuer
2530069MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190529003256 IL Practitioner - Pediatric MedicinePractitioner - Other (Physician) 7618937533 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35.084839OHMDPediatrics Physician
036.149430CAMDPediatric Adolescent Medicine Physician
DR.0067384COMDPediatric Adolescent Medicine Physician
036.149430ILMDPediatric Adolescent Medicine Physician
312011-01NYMDPediatric Adolescent Medicine Physician
MD432542PAMDPediatric Adolescent Medicine Physician
T4095TXMDPediatric Adolescent Medicine Physician
MD61181970WAMDPediatric Adolescent Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince May 15, 2019 Accepting new patients
Childrens Health Care Associates, Inc Pediatrics Current Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Advocate Health & Hospitals Corporation CurrentSince May 15, 2019 Accepting new patients
Lurie Children'S Medical Group, LLC Pediatrics Past Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

29373 Network Pl
Chicago, IL 60673

100 E Penn Sq
Fl 9
Philadelphia, PA 19107
Phone (267) 425-9232

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

3550 Market St
Fl 4
Philadelphia, PA 19104
Phone (215) 590-2178

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1083663538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 131747",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920131747",
            "telephone_number": "193-506-2906",
            "fax_number": "267-425-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2659 STATE ST STE 100",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920081627",
            "telephone_number": "619-350-6290",
            "fax_number": "619-436-4739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZUCKER",
        "first_name": "MICHELE",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-10",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.084839",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NY",
            "license": "312011-01",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "TX",
            "license": "T4095",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "WA",
            "license": "MD61181970",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CO",
            "license": "DR.0067384",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "PA",
            "license": "MD432542",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "OH",
            "license": "35.084839",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CA",
            "license": "036.149430",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "IL",
            "license": "036.149430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2530069",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carlsbad, CA

Sources for this page

Verify at the official NPI Registry.