Provider Demographics
NPI:1407055312
Name:DECKER MEDICAL ASSOCIATES LTD
Entity Type:Organization
Organization Name:DECKER MEDICAL ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALMEDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-748-7150
Mailing Address - Street 1:4001 VOLLMER
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1073
Mailing Address - Country:US
Mailing Address - Phone:708-748-7150
Mailing Address - Fax:708-747-6830
Practice Address - Street 1:4001 VOLLMER ROAD
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1073
Practice Address - Country:US
Practice Address - Phone:708-748-7150
Practice Address - Fax:708-747-6830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD89258Medicare UPIN