Kassandra Cooper Tucker, DO | |
530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | |
(309) 655-6710 | |
Not Available |
Full Name | Kassandra Cooper Tucker |
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Gender | Female |
Speciality | Emergency Medicine |
Location | 530 Ne Glen Oak Ave, Peoria, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1710393913 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207P00000X | Emergency Medicine | 125065930 (Illinois) | Primary |
Entity Name | Permanente Medical Group Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1073606299 PECOS PAC ID: 8921910225 Enrollment ID: O20031104000710 |
Mailing Address | Practice Location Address |
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Kassandra Cooper Tucker, DO 530 Ne Glen Ave Nb2624, Peoria, IL 61637 Ph: (309) 655-6710 | Kassandra Cooper Tucker, DO 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 Ph: (309) 655-6710 |
Dr. Austin Lamb, M.D. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 530 N.e. Glen Oak Avenue, Osf St. Francis, Emergency Medicine Residency Program, Peoria, IL 61637 Phone: 309-655-7257 | |
Philip A Fifield, M.D. Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2553 Fax: 309-655-2602 | |
Dr. Anthony J Buecker, M.D. Emergency Medicine Medicare: Medicare Enrolled Practice Location: 221 Ne Glen Oak Ave, Peoria, IL 61636 Phone: 309-672-5500 | |
Dr. Mark Phillip Gaudio, M.D. Emergency Medicine Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-6710 | |
Michael M Raso, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 1115 N Bourland Ave, Peoria, IL 61606 Phone: 309-264-0730 | |
Ryan Newberger, M.D. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 248-207-2018 | |
Craig D Koch, M.D Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-7257 |