Healthcare Provider Details

I. General information

NPI: 1164821732
Provider Name (Legal Business Name): MICHAEL DECK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 ARVILLE ST SUITE D
LAS VEGAS NV
89103-5402
US

IV. Provider business mailing address

2475 ROBB DR APT #1518
RENO NV
89523-2871
US

V. Phone/Fax

Practice location:
  • Phone: 702-830-9740
  • Fax: 702-830-9741
Mailing address:
  • Phone: 775-230-5396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: