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NPI Code Detail

MEDICARE: DR. WILLIAM DICKIESON D.P.M.

MEDICARE: DR. WILLIAM DICKIESON D.P.M.
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
1213EP1101XPrimary Podiatric Medicine Podiatrist001040MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1WD001040OTHERMIBLUE CROSS LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164480620
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM DICKIESON D.P.M.
Provider Business Mailing Address
First Line : 1213 MASON ST
Second Line :
City : DEARBORN
State : MI
Zip : 48124-2841
Country : US
Telephone Number : 313-561-2446
Fax Number :
Provider Business Practice Location Address
First Line : 1213 MASON ST
Second Line :
City : DEARBORN
State : MI
Zip : 48124-2841
Country : US
Telephone Number : 313-561-2446
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 07/09/2007

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