Healthcare Provider Details

I. General information

NPI: 1023035748
Provider Name (Legal Business Name): WILLIAM DICKIESON DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 MASON ST
DEARBORN MI
48124-2841
US

IV. Provider business mailing address

1213 MASON ST
DEARBORN MI
48124-2841
US

V. Phone/Fax

Practice location:
  • Phone: 313-561-2446
  • Fax: 313-561-7299
Mailing address:
  • Phone: 313-561-2446
  • Fax: 313-561-7299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number5901001040
License Number StateMI

VIII. Authorized Official

Name: MR. ALEX FAWAZ
Title or Position: MANAGER
Credential:
Phone: 248-219-0323