MEDICARE: DR. DORA DEAN DIXIE MD

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	207QA0401X	Addiction Medicine (Family Medicine) Physician		IL

General Provider Information

NPI Number	:	1225092919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DORA DEAN DIXIE MD

Provider Business Mailing Address
First Line	:	5421 S CORNELL AVE
Second Line	:	UNIT 13
City	:	CHICAGO
State	:	IL
Zip	:	60615-5646
Country	:	US
Telephone Number	:	773-324-5044
Fax Number	:	773-324-4604

Provider Business Practice Location Address
First Line	:	500 E 51ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-2400
Country	:	US
Telephone Number	:	312-572-2000
Fax Number	:

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	07/08/2007

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