Healthcare Provider Details

I. General information

NPI: 1851337646
Provider Name (Legal Business Name): MICHAEL DEEKEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 DEWEY AVE
WAUWATOSA WI
53213-2504
US

IV. Provider business mailing address

16130 SIESTA LN
BROOKFIELD WI
53005-3246
US

V. Phone/Fax

Practice location:
  • Phone: 414-454-6600
  • Fax: 414-454-6522
Mailing address:
  • Phone: 414-365-3210
  • Fax: 414-365-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number27956
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number27956
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: