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General NPI Number Information
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NPI Number | 1356780142
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Entity Type | Individual
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Provider Name | CRAIG L TUCKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2013
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 6420 DUTCHMANS PKWY STE 200
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City | LOUISVILLE
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State | KY
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Zip | 40205-3373
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Country | US
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Telephone | 502-891-8300
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Fax | 502-891-8338
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-3373
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301110805
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 53964
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License Number State | KY
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