Provider Demographics
NPI:1124594361
Name:MARK E DECHECK MD SC
Entity type:Organization
Organization Name:MARK E DECHECK MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:DECHECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-687-8685
Mailing Address - Street 1:3805B SPRING ST STE 250
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1643
Mailing Address - Country:US
Mailing Address - Phone:262-687-8685
Mailing Address - Fax:262-634-7935
Practice Address - Street 1:3805B SPRING ST STE 250
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53405-1643
Practice Address - Country:US
Practice Address - Phone:262-687-8685
Practice Address - Fax:262-634-7935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty