Provider Demographics
NPI:1992782478
Name:FUKUI, MIEKO (MD)
Entity type:Individual
Prefix:DR
First Name:MIEKO
Middle Name:
Last Name:FUKUI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:15 PARKMAN STREET
Practice Address - Street 2:WAC 626 ALLERGY ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-3850
Practice Address - Fax:617-724-0239
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA213106207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2042771Medicaid
MAJ27402OtherBCBS MA
MA468961OtherTUFTS HEALTH PLAN
MA468961OtherTUFTS HEALTH PLAN
I09861Medicare UPIN