Healthcare Provider Details

I. General information

NPI: 1487815601
Provider Name (Legal Business Name): CHRISTAL M DICKUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S HARBOR CITY BLVD
MELBOURNE FL
32901-1319
US

IV. Provider business mailing address

100 S HARBOR CITY BLVD
MELBOURNE FL
32901-1319
US

V. Phone/Fax

Practice location:
  • Phone: 844-856-2585
  • Fax: 321-259-1223
Mailing address:
  • Phone: 844-856-2585
  • Fax: 321-259-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25291
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA124247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: