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General NPI Number Information
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NPI Number | 1740210251
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Entity Type | Individual
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Provider Name | TUCKER GISLER JENNINGS MD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 33101 ANNAPOLIS ST STE 100
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City | WAYNE
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State | MI
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Zip | 48184-2405
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Country | US
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Telephone | 734-467-2670
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Fax |
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Provider Business Mailing Address
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Address Line | 26901 BEAUMONT BLVD
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3849
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Country | US
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Telephone |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301506625
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License Number State | MI
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