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General NPI Number Information
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NPI Number | 1487670162
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Entity Type | Individual
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Provider Name | PAULA K DEKEYSER D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 740 S MAIN ST
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City | CHEBOYGAN
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State | MI
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Zip | 49721-2220
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Country | US
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Telephone | 231-627-7118
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Fax | 231-627-1838
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Provider Business Mailing Address
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Address Line | PO BOX 419
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City | CHEBOYGAN
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State | MI
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Zip | 49721-0419
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Country | US
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Telephone | 231-627-1438
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Fax | 231-627-1471
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101013306
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License Number State | MI
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