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General NPI Number Information
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NPI Number | 1407067366
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Entity Type | Individual
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Provider Name | DAKARA A. RUCKER WRIGHT M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3031 W GRAND BLVD SUITE 800
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City | DETROIT
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State | MI
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Zip | 48202-3046
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Country | US
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Telephone | 313-916-2171
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Fax |
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Provider Business Mailing Address
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Address Line | 26380 BERG ROAD APT 316
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City | SOUTHFIELD
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State | MI
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Zip | 48034
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Country | US
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Telephone | 312-307-1319
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 4301087721
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License Number State | MI
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