MEDICARE: CHRISTAL M DICKUN 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	2083A0300X	Addiction Medicine (Preventive Medicine) Physician	ME162870	FL
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	ME162870	FL
3	208D00000X	General Practice Physician	0101268436	VA
4	207P00000X	Emergency Medicine Physician	ME162870	FL
5	207P00000X	Emergency Medicine Physician	0101268436	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487815601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTAL M DICKUN MD

Provider Business Mailing Address
First Line	:	1501 ROBERT J CONLAN BLVD NE STE 7
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-3559
Country	:	US
Telephone Number	:	321-479-4083
Fax Number	:	321-294-5036

Provider Business Practice Location Address
First Line	:	1501 ROBERT J CONLAN BLVD NE STE 7
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-3559
Country	:	US
Telephone Number	:	321-479-4083
Fax Number	:	321-294-5036

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

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	03/23/2026

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Directions to “ CHRISTAL M DICKUN MD” Practice Location

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