Provider Demographics
NPI:1558696054
Name:TUCCI, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:TUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2855 MICHIGAN ST NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-1221
Mailing Address - Country:US
Mailing Address - Phone:616-957-4090
Mailing Address - Fax:616-957-4095
Practice Address - Street 1:2855 MICHIGAN ST NE
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1221
Practice Address - Country:US
Practice Address - Phone:616-957-4090
Practice Address - Fax:616-957-4095
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2010-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI430107122282084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B64882Medicare UPIN