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General NPI Number Information
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NPI Number | 1679689541
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Entity Type | Organization
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Legal Business Name | DECATUR VEIN CLINIC, MICHIGAN, PC
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1669 HAMILTON RD SUITE 220
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City | OKEMOS
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State | MI
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Zip | 48864-1956
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Country | US
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Telephone | 517-381-1000
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Fax | 517-381-8751
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Provider Business Mailing Address
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Address Line | PO BOX 4237
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City | CARMEL
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State | IN
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Zip | 46082-4237
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Country | US
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Telephone | 317-218-2800
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Fax | 317-818-8919
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Authorized Official
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Title or Position | CEO
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Name | DAVID R DECATUR
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Credential | MD
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Telephone | 317-218-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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