Deckard, Jack Hudson

Deckard, Jack Hudson is an sole proprietor health care provider with primary practice located at 5150 N Port Washington Rd Ste 220, Glendale WI 53217-5474. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurological Surgery, which is considered as his primary health care specialty. Deckard, Jack Hudson can be contacted via phone (414) 961-0089.

Contact Information

Primary practice address
5150 N Port Washington Rd Ste 220 Glendale WI 53217-5474
Phone: (414) 961-0089
Fax: (414) 961-1043
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurological Surgery 207T00000X 24495 Wisconsin

Profile Details

NPI number 1689618571
LBN Legal business name Deckard, Jack Hudson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 15th, 2006
Last updated Aug 31st, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689618571 NPPES
Wisconsin MEDICAID 30464900

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