MEDICARE: DR. MICHAEL E. DECHERD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	K5504	TX

General Provider Information

NPI Number	:	1033163084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL E. DECHERD M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1073
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78294-1073
Country	:	US
Telephone Number	:	210-495-4100
Fax Number	:	210-495-4114

Provider Business Practice Location Address
First Line	:	414 W SUNSET RD
Second Line	:	SUITE 215
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1756
Country	:	US
Telephone Number	:	210-495-4100
Fax Number	:	210-495-4114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	04/29/2014

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