Provider Demographics
NPI:1376533463
Name:DECAESTECKER, JAMES E (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:DECAESTECKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 N MAIN ST
Mailing Address - Street 2:SUITE 233
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1180
Mailing Address - Country:US
Mailing Address - Phone:937-832-9310
Mailing Address - Fax:937-832-8613
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:SUITE 233
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1180
Practice Address - Country:US
Practice Address - Phone:937-832-9310
Practice Address - Fax:937-832-8613
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34007854208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2341282Medicaid
OH2341282Medicaid
OH4084055Medicare PIN
OH4084052Medicare PIN