Healthcare Provider Details

I. General information

NPI: 1922079995
Provider Name (Legal Business Name): DAVID BRUCE TUKEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 MONROE ST
DEARBORN MI
48124-2917
US

IV. Provider business mailing address

1922 MONROE ST
DEARBORN MI
48124-2917
US

V. Phone/Fax

Practice location:
  • Phone: 313-274-7540
  • Fax: 313-274-7544
Mailing address:
  • Phone: 313-274-7540
  • Fax: 313-274-7544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301051121
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: