Healthcare Provider Details

I. General information

NPI: 1851485510
Provider Name (Legal Business Name): CHRISTINE MARIE CUCCHI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 SUNCREST DR
LAPEER MI
48446-1154
US

IV. Provider business mailing address

1570 SUNCREST DR
LAPEER MI
48446-1154
US

V. Phone/Fax

Practice location:
  • Phone: 810-667-0500
  • Fax: 810-664-8728
Mailing address:
  • Phone: 810-667-0500
  • Fax: 810-664-8728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101014035
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: