Provider Demographics
NPI:1710212840
Name:DECKER, MICHAEL DONAHUE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DONAHUE
Last Name:DECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:TN
Mailing Address - Zip Code:38544-0425
Mailing Address - Country:US
Mailing Address - Phone:931-239-3663
Mailing Address - Fax:908-927-8674
Practice Address - Street 1:12500 COOKEVILLE BOATDOCK RD
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:TN
Practice Address - Zip Code:38544-4851
Practice Address - Country:US
Practice Address - Phone:931-239-3663
Practice Address - Fax:908-927-8674
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000014250207RI0200X
PAMD436437207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease