MEDICARE: KIRK M TUCKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35080892	OH
2	207R00000X	Internal Medicine Physician	35.080892	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093734501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK M TUCKER MD

Provider Business Mailing Address
First Line	:	1715 BROWN ST.
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45409-2624
Country	:	US
Telephone Number	:	937-208-9010
Fax Number	:	937-208-9020

Provider Business Practice Location Address
First Line	:	1715 BROWN ST.
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45409-2624
Country	:	US
Telephone Number	:	937-208-9010
Fax Number	:	937-208-9020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	05/31/2023

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Directions to “ KIRK M TUCKER MD” Practice Location

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