Provider Demographics
NPI:1124015870
Name:DECOCK, STEVEN V (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:V
Last Name:DECOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4629 S 162ND AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-1360
Mailing Address - Country:US
Mailing Address - Phone:402-895-1753
Mailing Address - Fax:
Practice Address - Street 1:4629 S 162ND AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1360
Practice Address - Country:US
Practice Address - Phone:402-895-1753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22365207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAC52344Medicare UPIN