Healthcare Provider Details

I. General information

NPI: 1376626127
Provider Name (Legal Business Name): PANY DECOSSARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3559 PINE STREET
DECKERVILLE MI
48427-0126
US

IV. Provider business mailing address

PO BOX 126
DECKERVILLE MI
48427-0126
US

V. Phone/Fax

Practice location:
  • Phone: 810-376-2835
  • Fax: 810-376-9713
Mailing address:
  • Phone: 810-376-2835
  • Fax: 810-376-9713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number267123
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number4301083294
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: