Healthcare Provider Details

I. General information

NPI: 1386762474
Provider Name (Legal Business Name): MICHELLE N. DIZON, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 ISLAND MEDICAL CENTER
ST. CROIX VI
00820
US

IV. Provider business mailing address

4500 ISLAND MEDICAL CENTER
ST. CROIX VI
00820
US

V. Phone/Fax

Practice location:
  • Phone: 370-778-5780
  • Fax: 340-713-1870
Mailing address:
  • Phone: 370-778-5780
  • Fax: 340-713-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number1192
License Number StateVI

VIII. Authorized Official

Name: MICHELLE N. DIZON
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 340-778-5780