Healthcare Provider Details

I. General information

NPI: 1790911246
Provider Name (Legal Business Name): MICHAEL A. DEKKER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14256 N NORTHSIGHT BLVD STE 110
SCOTTSDALE AZ
85260-3954
US

IV. Provider business mailing address

1923 E HAZELWOOD ST
PHOENIX AZ
85016-4614
US

V. Phone/Fax

Practice location:
  • Phone: 480-561-0141
  • Fax: 602-429-8447
Mailing address:
  • Phone: 954-319-8579
  • Fax: 602-429-8447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number006406
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number006406
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: