Individual
DR. GLENN A TUCKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3738 LANDMARK DR, STE D, LAFAYETTE, IN 47905-6654
(765) 449-7984
(765) 449-9791
Mailing address
6416 SHAMEL DR, INDIANAPOLIS, IN 46278-1170
(317) 876-1229
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
MD-40539
IA
2085R0202X
Diagnostic Radiology Physician
Primary
01039553A
IN
2085R0202X
Diagnostic Radiology Physician
MD-40539
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200020370B
—
IN
05
—
64882822
—
KY
Enumeration date
05/24/2005
Last updated
12/09/2020
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