Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | DD041485 | MI |
NPI | 1255320883 |
---|---|
Provider Name | Dr. Deepa Dixit |
First Address | Clinton Township, MI 48036-2051 |
Second Address | Clinton Township, MI 48036-2051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 04/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0305014821 | BLUE CROSS BLUE SHIELD MI (01) | MI |
1765213 | (05) | MI |
861098320 | AETNA (01) | MI |
861098320 | CIGNA (01) | MI |
A74697 | (02) | MI |
A74697 | HEALTH ALLIANCE PLAN MI (01) | MI |
P101616 | PREFERRED/CARE CHOICES (01) | MI |