MEDICARE: STEVEN V. DECOCK MD

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	207P00000X	Emergency Medicine Physician	22365	IA

General Provider Information

NPI Number	:	1124015870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN V. DECOCK MD

Provider Business Mailing Address
First Line	:	4629 S 162ND AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68135-1360
Country	:	US
Telephone Number	:	402-895-1753
Fax Number	:

Provider Business Practice Location Address
First Line	:	4629 S 162ND AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68135-1360
Country	:	US
Telephone Number	:	402-895-1753
Fax Number	:

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	07/08/2007

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