Provider Demographics
NPI:1902873151
Name:TUCKER, LAKEEYA K (DO)
Entity Type:Individual
Prefix:
First Name:LAKEEYA
Middle Name:K
Last Name:TUCKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LAKEEYA
Other - Middle Name:K
Other - Last Name:DOTSON TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1560 TURF LANE
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6392
Mailing Address - Country:US
Mailing Address - Phone:517-484-3000
Mailing Address - Fax:517-484-6358
Practice Address - Street 1:1560 TURF LANE
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6392
Practice Address - Country:US
Practice Address - Phone:517-484-3000
Practice Address - Fax:517-484-6358
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILT014020207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4387080Medicaid
MI5330320OtherBCBS/BCN PROVIDER #
MI0700261OtherPHP PROVIDER #
MI0770041OtherPHP FAMILY CARE PROVIDER
MI1006153OtherMCLAREN PROVIDER #
MIP00150117OtherRR MEDICARE PROVIDER #
MI4387080Medicaid
MI0700261OtherPHP PROVIDER #