Healthcare Provider Details

I. General information

NPI: 1760701866
Provider Name (Legal Business Name): LAURIE ANN DIXON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 BYRON RD
HOWELL MI
48843-1002
US

IV. Provider business mailing address

2000 GREEN RD STE 300
ANN ARBOR MI
48105-1575
US

V. Phone/Fax

Practice location:
  • Phone: 517-545-5318
  • Fax:
Mailing address:
  • Phone: 810-845-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301097246
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: