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NPI Code Detail

MEDICARE: IFIOKOBONG DANIEL DICKSON MD

MEDICARE: IFIOKOBONG DANIEL DICKSON 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
1207R00000XInternal Medicine Physician4351055191MI

General Provider Information

NPI Number : 1942195698
Entity Type Code : Individual
Provider Name (Legal Business Name) : IFIOKOBONG DANIEL DICKSON MD
Provider Business Mailing Address
First Line : 1675 LEAHY ST STE 315A
Second Line :
City : MUSKEGON
State : MI
Zip : 49442-5543
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1150 E SHERMAN BLVD STE 1100
Second Line :
City : MUSKEGON
State : MI
Zip : 49444-4607
Country : US
Telephone Number : 231-672-1690
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2025
Last Update Date : 06/12/2025

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Directions to “ IFIOKOBONG DANIEL DICKSON MD” Practice Location

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