MEDICARE: TUKEL -KOZLOW EYE CENTER, PC

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	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OH24984	OTHER	MI	BLUE CROSS GROUP NUMBER

General Provider Information

NPI Number	:	1679781306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUKEL -KOZLOW EYE CENTER, PC

Provider Business Mailing Address
First Line	:	1922 MONROE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2917
Country	:	US
Telephone Number	:	313-274-7540
Fax Number	:	313-274-7544

Provider Business Practice Location Address
First Line	:	1922 MONROE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2917
Country	:	US
Telephone Number	:	313-274-7540
Fax Number	:	313-274-7544

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID BRUCE TUKEL
Credential	:	MD
Telephone Number	:	313-274-7540

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/30/2020

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