Provider Demographics
NPI:1265007512
Name:USCHUK, MAXWELL JACKSON (MD)
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:JACKSON
Last Name:USCHUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MUNSON FAMILY PRACTICE CENTER
Mailing Address - Street 2:1400 MEDICAL CAMPUS DRIVE
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684
Mailing Address - Country:US
Mailing Address - Phone:231-935-8012
Mailing Address - Fax:231-935-8098
Practice Address - Street 1:MUNSON FAMILY PRACTICE CENTER
Practice Address - Street 2:1400 MEDICAL CAMPUS DRIVE
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-935-8012
Practice Address - Fax:231-935-8098
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4351047596207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program