Basic Information
| Provider Information | |||||||||
| NPI: | 1407055312 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DECKER MEDICAL ASSOCIATES LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4001 VOLLMER | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA FIELDS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604611073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087487150 | ||||||||
| FaxNumber: | 7087476830 | ||||||||
| Practice Location | |||||||||
| Address1: | 4001 VOLLMER ROAD | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA FIELDS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604611073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087487150 | ||||||||
| FaxNumber: | 7087476830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 07/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | DECKER | ||||||||
| AuthorizedOfficialFirstName: | ALMEDA | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7087487150 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.