Healthcare Provider Details

I. General information

NPI: 1730192410
Provider Name (Legal Business Name): MELINDA ANNA DIXON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINDA ANNA LOVE

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 TAYLOR STREET DETROIT HEALTH DEPT HERMAN KIEFER HEALTH COMPLEX
DETROIT MI
48202-1732
US

IV. Provider business mailing address

18464 SALEM
DETROIT MI
48219
US

V. Phone/Fax

Practice location:
  • Phone: 313-876-4720
  • Fax: 313-876-0070
Mailing address:
  • Phone: 313-533-7151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301047429
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: