Healthcare Provider Details

I. General information

NPI: 1912183328
Provider Name (Legal Business Name): MICHELE DEKORTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 E BARNETT RD
MEDFORD OR
97504-8332
US

IV. Provider business mailing address

2640 E BARNETT ROAD E333
MEDFORD OR
97504-8332
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-3200
  • Fax:
Mailing address:
  • Phone: 858-554-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD180313
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: