Individual
DR. JILL SUSANNE DECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
345 N DIVISION RD, SUITE D, PETOSKEY, MI 49770-9416
(231) 347-8382
(231) 347-6628
Mailing address
345 N DIVISION RD, SUITE D, PETOSKEY, MI 49770-9416
(231) 347-8382
(231) 347-6628
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
4301080589
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4440294
—
MI
Enumeration date
09/20/2006
Last updated
10/12/2007
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