Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | IL |
NPI | 1225092919 |
---|---|
Provider Name | Dr. Dora Dean Dixie |
First Address | Chicago, IL 60615-5646 |
Second Address | Chicago, IL 60615-2400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H86200 | (02) | IL |