Provider Demographics
NPI:1093786220
Name:DEETS, DAVID K (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:DEETS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:215 E 1ST ST
Mailing Address - Street 2:STE 326 KSB MEDICAL GROUP
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-3166
Mailing Address - Country:US
Mailing Address - Phone:815-284-5719
Mailing Address - Fax:815-285-5894
Practice Address - Street 1:215 E 1ST ST
Practice Address - Street 2:STE 326 KSB MEDICAL GROUP
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-3166
Practice Address - Country:US
Practice Address - Phone:815-284-5719
Practice Address - Fax:815-285-5894
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-0482660208D00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036048266Medicaid
ILL50815Medicare PIN
D09767Medicare UPIN