MEDICARE: DR. JOSHUA ROBERT DECKER DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	5901002241	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480026386	OTHER	MI	RAILROAD MEDICARE
2	1639341365	OTHER	MI	RAILROAD MEDICARE
3	OM71140	OTHER	MI	MEDICARE ID - TYPE UNSPECIFIED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	1266510001	OTHER	MI	ADMINISTAR
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639341365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA ROBERT DECKER DPM

Provider Business Mailing Address
First Line	:	4540 KALAMAZOO AVE SE
Second Line	:
City	:	KENTWOOD
State	:	MI
Zip	:	49508-4625
Country	:	US
Telephone Number	:	616-281-0666
Fax Number	:	616-281-0752

Provider Business Practice Location Address
First Line	:	1195 WILSON AVE NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-3493
Country	:	US
Telephone Number	:	616-453-8277
Fax Number	:	616-453-2002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2008
Last Update Date	:	09/29/2009

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