Decelles, John M

Decelles, John M is an individual health care provider with primary practice located at 611 E Douglas Rd Suite 309, Mishawaka IN 46545-1467. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Decelles, John M can be contacted via phone (574) 472-6450.

Contact Information

Primary practice address
611 E Douglas Rd Suite 309 Mishawaka IN 46545-1467
Phone: (574) 472-6450
Fax: (574) 472-6474
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 01051161 Indiana

Profile Details

NPI number 1841238490
LBN Legal business name Decelles, John M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 4th, 2006
Last updated Dec 4th, 2009 - about 17 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 1841238490 NPPES
Indiana Other 000000215219 BCBS
Indiana MEDICAID 200228210A BCBS
Indiana Other 021236800 BCBS

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