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Individual

PANY DECOSSARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3559 PINE STREET, DECKERVILLE, MI 48427-0126
(810) 376-2835
(810) 376-9713
Mailing address
PO BOX 126, DECKERVILLE, MI 48427-0126
(810) 376-2835
(810) 376-9713

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
267123
NY
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
4301083294
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4694760
MI
Enumeration date
10/23/2006
Last updated
05/05/2026
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