Healthcare Provider Details

I. General information

NPI: 1134183221
Provider Name (Legal Business Name): DONALD W DIXON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 04/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 EUCLID AVE SUITE 201
BERWYN IL
60402-3471
US

IV. Provider business mailing address

19001 OLD LAGRANGE RD
MOKENA IL
60448-8012
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-2055
  • Fax: 708-783-2181
Mailing address:
  • Phone: 708-478-3600
  • Fax: 708-478-3552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036047316
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036047316
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: