Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 117 | WI |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 036106353 | IL |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 117 | WI |
NPI | 1356373872 |
---|---|
Provider Name | Malcolm M Decamp |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-2927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 05/01/2021 |