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General NPI Number Information
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NPI Number | 1891959086
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Entity Type | Individual
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Provider Name | CHRISTOPHER M DICKINSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/16/2008
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Last Update Date | 02/14/2011
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Provider Practice Location Address
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Address Line | 3601 SW 160TH AVE SUITE 250
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City | MIRAMAR
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State | FL
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Zip | 33027-6308
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Country | US
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Telephone | 305-866-9951
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Fax | 877-284-8933
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Provider Business Mailing Address
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Address Line | 7 SAWYER AVE
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City | LA GRANGE
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State | IL
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Zip | 60525-2537
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Country | US
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Telephone | 815-440-1658
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036.126517
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036.126517
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License Number State | IL
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