Michael David Degould, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

019019722 Issued in IL

Practice address

2835 McFarland Rd
Suite C
Rockford, IL 61107-6819

Phone

(815) 654-0039

Fax

(815) 654-0650

NPI assigned

Apr 8, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective May 18, 2016 through May 18, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410307200000",
    "number": "1245673441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2835 MCFARLAND RD",
            "address_2": "SUITE C",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611076819",
            "telephone_number": "815-654-0039",
            "fax_number": "815-654-0650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2835 MCFARLAND RD",
            "address_2": "SUITE C",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611076819",
            "telephone_number": "815-654-0039",
            "fax_number": "815-654-0650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEGOULD",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-08",
        "last_updated": "2014-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019019722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Deckard-Gonzales
• Mara Elizabeth Decman, CCC-SLP
• Rodica Dedu
• Laura Ann Dee, PHARMD
• Janelle D Defilippis, APN
• John J Deguide, M.D.
• Susan J Deguide, M.D.
• Charles Scott Dehaan, M.D.
• Misty Lynn Dehaven, APN
• George W. Dehoff III, MD

• Oral and Maxillofacial Surgery (Dentist) in Rockford, IL
• Providers in Rockford, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.