Provider Demographics
NPI:1679561237
Name:TUCKER, STEVEN G (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:TUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 N STATE ROAD 7
Mailing Address - Street 2:SUITE 316
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5884
Mailing Address - Country:US
Mailing Address - Phone:954-967-6400
Mailing Address - Fax:954-967-6410
Practice Address - Street 1:1610 NE MIAMI GARDENS DR
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4900
Practice Address - Country:US
Practice Address - Phone:305-940-6016
Practice Address - Fax:305-940-6167
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46308208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371923500Medicaid
D50841Medicare UPIN