Provider Demographics
NPI:1194892265
Name:DRS DECHECK AND MATACZYNSKI MD SC
Entity type:Organization
Organization Name:DRS DECHECK AND MATACZYNSKI MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:MATACZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-634-6679
Mailing Address - Street 1:3805B SPRING ST
Mailing Address - Street 2:SUITE250
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1641
Mailing Address - Country:US
Mailing Address - Phone:262-634-6679
Mailing Address - Fax:262-634-7935
Practice Address - Street 1:3805B SPRING ST
Practice Address - Street 2:SUITE250
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53405-1641
Practice Address - Country:US
Practice Address - Phone:262-634-6679
Practice Address - Fax:262-634-7935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31598100Medicaid
E59563Medicare UPIN
E59563Medicare UPIN