Individual
ANTHONY R PUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
416 CONNABLE AVE, PETOSKEY, MI 49770-2212
(231) 487-4000
Mailing address
330 E MITCHELL ST, SUITE 210, PETOSKEY, MI 49770-2671
(866) 287-5269
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5101010113
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3152410324
BCBS
MI
01
—
AP010113
BCBS
MI
01
—
P00227931
RAILROAD MEDICARE
MI
Enumeration date
07/18/2005
Last updated
07/08/2007
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