MEDICARE: DAVID TUCKER

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	101Y00000X	Counselor	6451024451	MI

General Provider Information

NPI Number	:	1780553214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID TUCKER

Provider Business Mailing Address
First Line	:	1101 E MINER RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44124-1701
Country	:	US
Telephone Number	:	440-487-3815
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 E WASHINGTON ST STE 602
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-2012
Country	:	US
Telephone Number	:	734-201-5832
Fax Number	:

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

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	11/03/2025

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Directions to “ DAVID TUCKER ” Practice Location

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