Provider Demographics
NPI:1942205208
Name:DECKER, WILLIAM CLARK (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CLARK
Last Name:DECKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 KIMOLE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1400
Mailing Address - Country:US
Mailing Address - Phone:517-265-3411
Mailing Address - Fax:517-263-7694
Practice Address - Street 1:777 KIMOLE LN STE 100
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1400
Practice Address - Country:US
Practice Address - Phone:517-265-3411
Practice Address - Fax:517-263-7694
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009355207RC0200X, 207RP1001X
OH34.008398207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI03877OtherPARAMOUNT HEALTHCARE
MI1154600085OtherBCBSM
OH2032884Medicaid
MI2649747Medicaid
MI2649747Medicaid
MI03877OtherPARAMOUNT HEALTHCARE
MI1154600085OtherBCBSM
MIE80778Medicare UPIN