Individual
KENNETH TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11900 E 12 MILE RD, SUITE 300, WARREN, MI 48093-3400
(586) 751-2072
(586) 751-1302
Mailing address
11900 E 12 MILE RD, SUITE 300, WARREN, MI 48093-3400
(586) 751-2072
(586) 751-1302
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
4301024231
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1672544
—
MI
01
—
700H273300
BCBSM
MI
01
—
KT024231
BCBSM OTHER IDENTIFIER
MI
Enumeration date
07/05/2005
Last updated
02/16/2015
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