Provider Demographics
NPI:1679703920
Name:HOWARD J TUCKER MD INC
Entity type:Organization
Organization Name:HOWARD J TUCKER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-333-6545
Mailing Address - Street 1:20545 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3430
Mailing Address - Country:US
Mailing Address - Phone:440-333-6545
Mailing Address - Fax:440-331-7710
Practice Address - Street 1:2801 N PARK BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-4030
Practice Address - Country:US
Practice Address - Phone:440-333-6545
Practice Address - Fax:440-331-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35015264207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8901906Medicaid
OHA69093Medicare UPIN