Individual
CONSTANTINA C. TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
505 WEST LINCOLN HWY, SCHERERVILLE, IN 46375-1554
(219) 311-3311
Mailing address
505 WEST LINCOLN HWY, SCHERERVILLE, IN 46375-1554
(219) 311-3311
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02004498A
IN
207Q00000X
Family Medicine Physician
5101016610
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036121455
STATE LICENSE
IL
Enumeration date
04/09/2007
Last updated
08/29/2019
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