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Individual
CONSTANTINA C. TUCKER
Active
Individual
CONSTANTINA C. TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02004498A
IN
207Q00000X
Family Medicine Physician
5101016610
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036121455
STATE LICENSE
IL
Enumeration date
04/09/2007
Last updated
08/29/2019
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