Healthcare Provider Details

I. General information

NPI: 1336028588
Provider Name (Legal Business Name): DEKKER MEDICAL INDUSTRIAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL ALLEN DEKKER
Title or Position: OWNER
Credential: DO
Phone: 954-319-8579