Individual
DR. JACK A DEKKINGA
Active
Individual
DR. JACK A DEKKINGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
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