Provider Demographics
NPI:1053373894
Name:MICHAEL A DECK MD PA
Entity type:Organization
Organization Name:MICHAEL A DECK MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:DECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-981-3107
Mailing Address - Street 1:6124 W PARKER RD
Mailing Address - Street 2:STE G36
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-981-3107
Mailing Address - Fax:972-981-3236
Practice Address - Street 1:6124 W PARKER RD
Practice Address - Street 2:STE G36
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-981-3107
Practice Address - Fax:972-981-3236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0089CCMedicare PIN
TXCG5746Medicare PIN