MEDICARE: VIKRAM DEKA 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	208600000X	Surgery Physician	43373	AZ
2	2086S0127X	Trauma Surgery Physician	43373	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306040498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIKRAM DEKA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 33269
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85067-3269
Country	:	US
Telephone Number	:	602-406-4786
Fax Number	:	916-636-4358

Provider Business Practice Location Address
First Line	:	10214 N TATUM BLVD STE A600
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-4247
Country	:	US
Telephone Number	:	602-406-1530
Fax Number	:	602-406-1539

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

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	11/19/2024

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Directions to “ VIKRAM DEKA M.D.” Practice Location

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