Individual
MICHAEL TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
5171 N SANTA MONICA BLVD, APT 4, MILWAUKEE, WI 53217-5538
(414) 828-7761
Mailing address
5171 N SANTA MONICA BLVD, APT 4, MILWAUKEE, WI 53217-5538
(414) 828-7761
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3630-23
WI
Other
Enumeration date
07/22/2015
Last updated
12/02/2021
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