Provider Demographics
NPI:1982795050
Name:DEKORTE, MICHAEL ANDREW (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:DEKORTE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 GOLF VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9643
Mailing Address - Country:US
Mailing Address - Phone:541-770-1225
Mailing Address - Fax:541-770-1245
Practice Address - Street 1:713 GOLF VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9643
Practice Address - Country:US
Practice Address - Phone:541-770-1225
Practice Address - Fax:541-770-1245
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00247213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR056981Medicaid
OR1297890041OtherCIGNA (DMERC)
OR480029243OtherRAILROAD MEDICARE
OR056981Medicaid
ORR105172Medicare PIN