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NPI Code Detail

MEDICARE: MICHAEL DEEKEN MD

MEDICARE: MICHAEL DEEKEN 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
12084P0802XAddiction Psychiatry Physician27956WI
22084P0800XPsychiatry Physician27956WI

Other Identifiers

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

General Provider Information

NPI Number : 1851337646
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL DEEKEN MD
Provider Business Mailing Address
First Line : 16130 SIESTA LN
Second Line :
City : BROOKFIELD
State : WI
Zip : 53005-3246
Country : US
Telephone Number : 414-365-3210
Fax Number : 414-365-3225
Provider Business Practice Location Address
First Line : 1220 DEWEY AVE
Second Line :
City : WAUWATOSA
State : WI
Zip : 53213-2504
Country : US
Telephone Number : 414-454-6600
Fax Number : 414-454-6522
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2006
Last Update Date : 12/09/2011

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