Provider Demographics
NPI:1891978391
Name:UCKUN, FATIH M (MD)
Entity Type:Individual
Prefix:
First Name:FATIH
Middle Name:M
Last Name:UCKUN
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 1:2848 PATTON RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1100
Mailing Address - Country:US
Mailing Address - Phone:651-628-0098
Mailing Address - Fax:651-796-5378
Practice Address - Street 1:2848 PATTON RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1100
Practice Address - Country:US
Practice Address - Phone:651-628-0098
Practice Address - Fax:651-796-5378
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36852207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G26526Medicare UPIN