KENNETH TUCKER (NPI# 1669479846) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669479846 |
| Entity Type | Individual |
| Full Name | KENNETH TUCKER |
| Credential | MD |
| Practice Address |
11900 E 12 Mile Rd Suite 300 Warren MI 48093-3400 |
| Practice Telephone | 5867512072 |
| Practice Fax Number | 5867511302 |
| Mailing Telephone | 5867512072 |
| Mailing Fax Number | 5867511302 |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2015-02-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
4301024231 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1672544 | 05 | |
| MI | BCBSM OTHER IDENTIFIER | KT024231 | 01 |
| MI | BCBSM | 700H273300 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346518537 | Kenneth Richard Tucker | Plastic Surgery | 22843 Tranquility Pl Ne, Kingston, WA 98346-8241 | 2011-12-02 |
| 1861402596 | Kenneth S Tucker | Counselor | 1956 Ne 5th Ave, Suite 7, Boca Raton, FL 33431-7772 | 2006-08-08 |
| 1114280997 | Kenneth Wayne Tucker | Registered Nurse | 405 E Georgia Ave, Ruston, LA 71270-3926 | 2012-06-18 |
| 1346294204 | Kenneth B Tucker | Internal Medicine | 1118 Ross Clark Cir, Suite 100, Dothan, AL 36301-3001 | 2006-05-22 |
| 1225006430 | Kenneth A Tucker | Physical Therapist | 711 D St, #102, San Rafael, CA 94901-3707 | 2006-03-14 |
| Street Address |
11900 E 12 MILE RD SUITE 300 |
| City | WARREN |
| State | MI |
| Zip Code | 48093-3400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194720276 | Stuart R Gildenberg | Dermatology | 11900 E 12 Mile Rd, Ste 201, Warren, MI 48093-3490 | 2005-06-16 |
| 1902459159 | Tammy Jean Cass | Registered Nurse | 11900 E 12 Mile Rd, Warren, MI 48093-3400 | 2019-07-17 |
| 1437715026 | Dalia Hasso | Student in an Organized Health Care Education/Training Program | 11900 E 12 Mile Rd, Warren, MI 48093-3400 | 2019-05-19 |
| 1174070577 | Hayley Foster | Physician Assistant | 11900 E 12 Mile Rd, Suite 110, Warren, MI 48093-3400 | 2016-09-02 |
| 1063872877 | Andrew Cox | Physician Assistant | 11900 E 12 Mile Rd, Suite 110, Warren, MI 48093-3400 | 2016-03-07 |
| 1194115402 | Lingareddy Devireddy Md PC | Clinic/Center | 11900 E 12 Mile Rd, Suite 103, Warren, MI 48093-3400 | 2015-01-26 |
| 1538561469 | Erica Williams | Physician Assistant | 11900 E 12 Mile Rd, Suite 110, Warren, MI 48093-3400 | 2014-09-23 |
| 1578994737 | Mendelson Orthopedics | Orthopaedic Surgery | 11900 E 12 Mile Rd, Suite 105, Warren, MI 48093-3400 | 2013-12-12 |
| 1548542020 | Brittany J Miller | Physician Assistant | 11900 E 12 Mile Rd, Suite 100, Warren, MI 48093-3400 | 2011-09-12 |
| 1285916825 | Theresa Jeanette Richardson | Physician Assistant | 11900 E 12 Mile Rd, Suite 100, Warren, MI 48093-3400 | 2011-09-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023615986 | Toleka Regina Taylor | Nurse Anesthetist, Certified Registered | St. John Macomb Hospital, 11800 East 12 Mile Road, Warren, MI 48093 | 2020-10-05 |
| 1679112676 | Open Heart Communities | Case Management | 31310 Shaw Dr, Warren, MI 48093 | 2019-12-23 |
| 1538715636 | 3 Dove Medical Supplies | Durable Medical Equipment & Medical Supplies | 31201 Chicago Rd S Ste C101, Warren, MI 48093 | 2019-08-14 |
| 1568954600 | Schreiber Cardiology, P.C. | Internal Medicine | 8545 Common Rd Ste 150, Warren, MI 48093 | 2018-06-05 |
| 1730686197 | Lambro Seremetis | Social Worker | 12200 E. 12 Mile Road, Ste. 200, Warren, MI 48093 | 2018-04-11 |
| 1649775826 | Ridge Downs | Behavioral Analyst | 31201 Chicago Rd South, Suite C- 202, Warren, MI 48093 | 2018-03-28 |
| 1144722737 | Jessica Farraj | Occupational Therapist | 11800 E. 12 Mile Road, Warren, MI 48093 | 2018-02-28 |
| 1265930168 | Leah Hanrahan | Registered Nurse | 11700 Amberle Dr., Warren, MI 48093 | 2018-01-25 |
| 1598271553 | Pamela Marie Confer | Occupational Therapist | 11012 13 Mile Rd, Suite 200, Warren, MI 48093 | 2017-12-28 |
| 1831604347 | Kate Jeanne Szczepanski | Behavior Technician | 31200 Chicago Rd S, Warren, MI 48093 | 2017-12-06 |
| Find all providers in zip 48093 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346887692 | Michigan Center for Hematology and Oncology | Internal Medicine | 28111 Hoover Rd Ste 5a, Warren, MI 48093-4153 | 2019-12-05 |
| 1275859704 | Elon Knoll | Internal Medicine | 11885 E 12 Mile Rd Ste 100a, Warren, MI 48093-3465 | 2010-04-08 |
| 1114134632 | Mohammad Mobayed | Internal Medicine | 25625 Schoenherr Rd Ste 300, Warren, MI 48089-1499 | 2007-05-16 |
| 1972568087 | Vijayalakshmi Donthireddy | Internal Medicine | Macomb Hematology Oncology, 11900 East 12mile Suite 210, Warren, MI 48093 | 2006-04-20 |
| 1073517835 | Lori C Hemrock | Internal Medicine | 1745 Niles Cortland Rd Ne Ste 5, Warren, OH 44484-6046 | 2005-06-09 |
| 1396364329 | Macomb Cancer and Blood Specialists, PC | Internal Medicine | 25625 Schoenherr Rd Ste 300, Warren, MI 48089-1499 | 2020-04-09 |
| 1376028506 | Verdi Oncology Michigan PC | Internal Medicine | 11900 E 12 Mile Rd Ste 308, Warren, MI 48093-3491 | 2018-10-03 |
| 1467693895 | Zeina Geryes El Amil | Internal Medicine | 667 Eastland Ave Se, Warren, OH 44484-4503 | 2009-03-16 |
| 1770731556 | Valeriy Sedov | Internal Medicine | 2 W Crescent Park, Warren, PA 16365 | 2008-09-04 |
| 1467487397 | Roger Hakimian | Internal Medicine | 1745 Niles Cortland Rd Ne Ste 5, Warren, OH 44484 | 2006-07-11 |
| Find all providers in WARREN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.