Healthcare Provider Details

I. General information

NPI: 1356373872
Provider Name (Legal Business Name): MALCOLM M DECAMP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/24/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8907 CTH S
MT. HOREB WI
53572
US

IV. Provider business mailing address

8907 CTH S
MT. HOREB WI
53572
US

V. Phone/Fax

Practice location:
  • Phone: 224-300-1244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number117
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036106353
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number117
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: