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General NPI Number Information
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NPI Number | 1093786220
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Entity Type | Individual
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Provider Name | DAVID K DEETS M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 10/17/2008
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Provider Practice Location Address
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Address Line | 215 E 1ST ST STE 326 KSB MEDICAL GROUP
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City | DIXON
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State | IL
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Zip | 61021-3166
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Country | US
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Telephone | 815-284-5719
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Fax | 815-285-5894
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Provider Business Mailing Address
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Address Line | 215 E 1ST ST STE 326 KSB MEDICAL GROUP
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City | DIXON
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State | IL
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Zip | 61021-3166
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Country | US
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Telephone | 815-284-5719
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Fax | 815-285-5894
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036-0482660
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 036-0482660
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License Number State | IL
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