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Individual

MICHAEL DECANDIA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1401 E 8TH ST, WESLACO, TX 78596-6640
(956) 581-0303
Mailing address
2121 E GRIFFIN PKWY, SUITE 12, MISSION, TX 78572-3241
(956) 581-0303

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
K3152
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DC0004
MEDICARE RAILROAD GRP
TX
01
P00141786
MEDICARE RAILROAD INDV
TX
Enumeration date
08/30/2006
Last updated
11/02/2007
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