Dekkinga, Jack A

Dekkinga, Jack A is an individual health care provider with primary practice located at 1673 Gezon Pkwy Sw , Wyoming MI 49519-9519. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery. Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery is his primary health care specialty. Dekkinga, Jack A can be contacted via phone (616) 243-3376.

Contact Information

Primary practice address
1673 Gezon Pkwy Sw Wyoming MI 49519-9519
Phone: (616) 243-3376
Fax: (616) 243-3377
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 4301039679 Michigan
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery 207ND0101X 5601039679 Michigan

Profile Details

NPI number 1255365334
LBN Legal business name Dekkinga, Jack A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2006
Last updated Feb 22nd, 2022 - about 3 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 1255365334 NPPES
Michigan Other 070D16223 BCBS MI
Michigan Other DX9137 BCBS MI
Michigan MEDICAID 1255365334 BCBS MI
Michigan Other MI11296 BCBS MI

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