Healthcare Provider Details

I. General information

NPI: 1912980236
Provider Name (Legal Business Name): MARK DIXON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 E US HIGHWAY 6 STE 300
VALPARAISO IN
46383-8948
US

IV. Provider business mailing address

85 E US HIGHWAY 6 STE 300
VALPARAISO IN
46383-8948
US

V. Phone/Fax

Practice location:
  • Phone: 219-983-6300
  • Fax: 219-983-6080
Mailing address:
  • Phone: 219-983-6300
  • Fax: 219-983-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number02001376
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: