| Doctor Name: | DR. JEFFREY EUGENE PUCCIO |
| NPI Number: | 1275507733 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 4301052835 |
| Business Practice Address: | 2021 Monroe St Suite 101 Dearborn, MI - 481242926 |
| Business Phone Number: | 3132774177 |
| Business Fax Number: | 3132772157 |
| Mailing Address: | 47830 Beckenham Blvd, NOVI |
| State: | MI |
| Postal Code: | 483743530 |
| Phone Number: | 2483477808 |
| Fax Number: | 2483477823 |
| NPI Enumeration Date: | 02/13/2006 |
| NPI Last Update Date: | 07/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 4301052835 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |