MEDICARE: DR. MATTHEW EDMUND BOYD DIXON M.D.

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2086X0206X	Surgical Oncology Physician	036159866	IL

General Provider Information

NPI Number	:	1083842009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW EDMUND BOYD DIXON M.D.

Provider Business Mailing Address
First Line	:	1725 W HARRISON ST STE 810
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3863
Country	:	US
Telephone Number	:	312-942-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST STE 810
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3863
Country	:	US
Telephone Number	:	312-942-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	06/01/2022

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