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General NPI Number Information
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NPI Number | 1619245461
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Entity Type | Organization
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Legal Business Name | JEFFREY E. PUCCIO M.D., P.C.
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 2021 MONROE ST SUITE 101
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City | DEARBORN
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State | MI
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Zip | 48124-2926
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Country | US
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Telephone | 313-277-4177
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Fax | 313-277-4157
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Provider Business Mailing Address
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Address Line | 2021 MONROE ST SUITE 101
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City | DEARBORN
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State | MI
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Zip | 48124-2926
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Country | US
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Telephone | 313-277-4177
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Fax | 313-277-4157
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY E PUCCIO
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Credential | M.D.
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Telephone | 313-277-4177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 4301052835
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License Number State | MI
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