MEDICARE: ANNU DEEPAK DIXIT 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	390200000X	Student in an Organized Health Care Education/Training Program	BP10068733	TX
2	207V00000X	Obstetrics & Gynecology Physician	U3507	TX

General Provider Information

NPI Number	:	1912564857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNU DEEPAK DIXIT MD

Provider Business Mailing Address
First Line	:	500 W MAIN ST STE 260
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75057-3640
Country	:	US
Telephone Number	:	940-591-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W MAIN ST STE 260
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75057-3640
Country	:	US
Telephone Number	:	940-591-6700
Fax Number	:

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

Provider Enumeration Date	:	05/27/2019
Last Update Date	:	09/13/2023

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