Basic Information
| Provider Information | |||||||||
| NPI: | 1619139326 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZUCHELLI | ||||||||
| FirstName: | TOBIAS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 317 N BROAD ST | ||||||||
| Address2: | APT# 408 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191071014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739108465 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2799 W GRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482022608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006536568 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2008 | ||||||||
| LastUpdateDate: | 05/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301106858 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MT193649 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 4301106858 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.