Individual
TUCKER GISLER JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
33101 ANNAPOLIS ST STE 100, WAYNE, MI 48184-2405
(734) 467-2670
Mailing address
26901 BEAUMONT BLVD, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301506625
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020049281
RAILROAD MEDICARE
—
05
—
2258506
—
OH
05
—
3002472000
—
WV
05
—
64073851
—
KY
Enumeration date
07/03/2006
Last updated
04/16/2025
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