Provider Demographics
NPI:1598715971
Name:TUCKER, PETER GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:GEORGE
Last Name:TUCKER
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 1:655 W 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-1850
Mailing Address - Country:US
Mailing Address - Phone:248-588-2468
Mailing Address - Fax:248-585-4210
Practice Address - Street 1:655 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1850
Practice Address - Country:US
Practice Address - Phone:248-588-2468
Practice Address - Fax:248-585-4210
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD056753L207Q00000X
CAA76965207Q00000X
MI4301089327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine