Provider Demographics
NPI:1154385672
Name:TOOKER, RICHARD MARC (MD, MPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARC
Last Name:TOOKER
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 122ND AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-9511
Mailing Address - Country:US
Mailing Address - Phone:269-673-5411
Mailing Address - Fax:269-673-4172
Practice Address - Street 1:3255 122ND AVE
Practice Address - Street 2:STE 200
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-9511
Practice Address - Country:US
Practice Address - Phone:269-673-5411
Practice Address - Fax:269-673-4172
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010444872083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10926OtherHEALTH PLAN OF MICHIGAN
MI118700OtherGREAT LAKES HEALTH PLAN
MI164490661Medicaid
MI6004860OtherMOLINA HEALTHCARE
MIOP390039OtherMCARE
MI386004860050OtherCOMMUNITY CHOICE
MI771860393Medicaid
MI386004860052OtherCOMMUNITY CHOICE
MIP00055287Medicare PIN
MI771860393Medicaid
MI386004860052OtherCOMMUNITY CHOICE