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NPI Code Detail

MEDICARE: DR. MADELINE ANN DICKS D.O.

MEDICARE: DR. MADELINE ANN DICKS D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician95301GA
2208100000XPhysical Medicine & Rehabilitation Physician19484ND
3390200000XStudent in an Organized Health Care Education/Training Program
4208100000XPhysical Medicine & Rehabilitation Physician010088AZ

General Provider Information

NPI Number : 1154857209
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MADELINE ANN DICKS D.O.
Provider Business Mailing Address
First Line : 240 W THOMAS RD # 301
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-4407
Country : US
Telephone Number : 602-406-7765
Fax Number :
Provider Business Practice Location Address
First Line : 222 W THOMAS RD STE 114
Second Line :
City : PHOENIX
State : AZ
Zip : 85013-4420
Country : US
Telephone Number : 602-406-6304
Fax Number : 602-406-6302
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2017
Last Update Date : 10/16/2024

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