Individual
TUCKER D BENJAMIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, PA-C
Contact information
Practice address
750 E TERRA COTTA AVE STE B, CRYSTAL LAKE, IL 60014-3621
(815) 759-6363
(815) 759-6360
Mailing address
260 E CONGRESS PKWY STE D, CRYSTAL LAKE, IL 60014-6235
(815) 759-6363
(815) 759-6360
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085005769
IL
Other
Enumeration date
03/22/2012
Last updated
12/30/2024
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