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Cody Michael-ty Deck
Student in an Organized Health Care Education/Training Program in Peoria, Illinois
NPI 1720669591

Cody Michael-ty Deck is a Student in an Organized Health Care Education/Training Program based in Oakwood, IL. Cody Michael-ty Deck practices in Peoria, IL. The NPI Number for Cody Michael-ty Deck is 1720669591 and holds a License No. (Illinois).

The current practice location address for Cody Michael-ty Deck is 815 Main St Ste C, Peoria, IL and can be reached out via phone at 309-672-4977.

Location: 815 Main St Ste C, Peoria, IL, 61858-6303
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1720669591
Provider Name
Cody Michael-ty Deck
Credential
Provider Entity Type
Individual
Gender
Male
Address
815 Main St Ste C, Peoria, IL, 61858-6303
Phone Number
309-672-4977
Fax Number
Provider Enumeration Date
04/14/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
815 Main St Ste C
City
Peoria
State
Illinois
Zip
61602-1080
Phone Number
309-672-4977
Fax Number
person
Provider Business Mailing Address Details
Address
815 Main St Ste C
City
Peoria
State
Illinois
Zip
61602-1080
Phone Number
309-672-4977
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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