Individual
DR. JACK A DEKKINGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1673 GEZON PKWY SW, WYOMING, MI 49519-9519
(616) 243-3376
(616) 243-3377
Mailing address
1673 GEZON PKWY SW, WYOMING, MI 49519-9519
(616) 243-3376
(162) 433-3776
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
4301039679
MI
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
5601039679
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070D16223
BCBS MI
MI
05
—
1255365334
—
MI
01
—
DX9137
MEDICARE RR GROUP
—
01
—
MI11296
MEDICARE PTAN GROUP
—
Enumeration date
07/11/2006
Last updated
02/22/2022
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us