Individual
MARK H TUCKER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5050 SCHAEFER RD, DEARBORN, MI 48126-3249
(313) 581-2600
(313) 581-0228
Mailing address
143 FOREST GLEN DR, HOLLAND, OH 43528-9207
(419) 861-0008
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301037522
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024244
MIDWEST HEALTH PLAN
MI
Enumeration date
06/05/2006
Last updated
07/08/2007
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