Individual
BRIAN J DECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7782 20TH AVE, JENISON, MI 49428
(616) 685-8700
Mailing address
245 STATE ST SE, GRAND RAPIDS, MI 49503
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301084359
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301084359
STATE LICENSE NUMBER
MI
Enumeration date
08/15/2006
Last updated
09/12/2012
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