Healthcare Provider Details

I. General information

NPI: 1326139270
Provider Name (Legal Business Name): CHERYL DICKSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 OAKLAND DRIVE
KALAMAZOO MI
49008
US

IV. Provider business mailing address

1000 OAKLAND DRIVE
KALAMAZOO MI
49008
US

V. Phone/Fax

Practice location:
  • Phone: 269-337-6400
  • Fax:
Mailing address:
  • Phone: 269-337-4507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number25MA03976200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA03976200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA39762
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301104278
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: