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NPI Code Detail

MEDICARE: DICKINSON NEUROLOGY ASSOCIATES P C

MEDICARE: DICKINSON NEUROLOGY ASSOCIATES P C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11477548311OTHERMIINDIVIDUAL NPI
21780678318OTHERMIINDIVIDUAL NPI
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033266408
Entity Type Code : Organization
Provider Name (Legal Business Name) : DICKINSON NEUROLOGY ASSOCIATES P C
Provider Business Mailing Address
First Line : 1205 PYLE DR
Second Line :
City : KINGSFORD
State : MI
Zip : 49802-1132
Country : US
Telephone Number : 906-779-7100
Fax Number :
Provider Business Practice Location Address
First Line : 1205 PYLE DR
Second Line :
City : KINGSFORD
State : MI
Zip : 49802-1132
Country : US
Telephone Number : 906-779-7100
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. PATTI PETERSON
Credential : MD
Telephone Number : 906-779-7100
Provider Enumeration Date : 01/05/2007
Last Update Date : 01/07/2013

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Practice Location Address:
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