MEDICARE: JACQUELINE A TUNG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	242443	MA

General Provider Information

NPI Number	:	1255502027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE A TUNG MD

Provider Business Mailing Address
First Line	:	3264 N EVERGREEN DR NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-9746
Country	:	US
Telephone Number	:	616-363-7339
Fax Number	:	616-361-5828

Provider Business Practice Location Address
First Line	:	50 HOWARD ST
Second Line	:	UNIT 3
City	:	SOMERVILLE
State	:	MA
Zip	:	02144-2735
Country	:	US
Telephone Number	:	617-764-2796
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	05/24/2012

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