Provider Demographics
NPI:1437257433
Name:DAVID A DECKER MD
Entity Type:Organization
Organization Name:DAVID A DECKER MD
Other - Org Name:CANCER CARE ASSOCIATES PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL SVCS MNGR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-997-9000
Mailing Address - Street 1:3577 W 13 MILE RD
Mailing Address - Street 2:STE 404
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3577 W 13 MILE RD
Practice Address - Street 2:STE 404
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:245-997-9000
Practice Address - Fax:248-997-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301041127332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
2367325OtherOTHER ID NUMBER-COMMERCIAL NUMBER