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NPI Code Detail

MEDICARE: MR. CHRISTOPHER J. TUCKER MT-BC

MEDICARE: MR. CHRISTOPHER J. TUCKER MT-BC
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
1225A00000XMusic Therapist07872

General Provider Information

NPI Number : 1366680142
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHRISTOPHER J. TUCKER MT-BC
Provider Business Mailing Address
First Line : 1669 W MAPLE RD
Second Line :
City : BIRMINGHAM
State : MI
Zip : 48009-1230
Country : US
Telephone Number : 248-646-3347
Fax Number :
Provider Business Practice Location Address
First Line : 1669 W MAPLE RD
Second Line :
City : BIRMINGHAM
State : MI
Zip : 48009-1230
Country : US
Telephone Number : 248-646-3347
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2009
Last Update Date : 02/01/2009

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