Provider Demographics
NPI:1023046844
Name:DECKER, WILLIAM ROBERT (DPM)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:DECKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5175 PLAINFIELD NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1048
Mailing Address - Country:US
Mailing Address - Phone:616-453-0294
Mailing Address - Fax:616-726-1492
Practice Address - Street 1:1195 WILSON NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-6404
Practice Address - Country:US
Practice Address - Phone:616-453-8277
Practice Address - Fax:616-453-2002
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000997213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480026385OtherRAILROAD MEDICARE
MI3506776Medicaid
MI1266510001OtherADMINISTAR
MI0M71140Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.
MI3506776Medicaid