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NPI Code Detail

MEDICARE: DAVID MICHAEL DICK MD

MEDICARE: DAVID MICHAEL DICK MD
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
1207RC0000XCardiovascular Disease PhysicianG6068TX
2207RI0011XInterventional Cardiology PhysicianG6068TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1038709308OTHERTXUNITED HEALTHCARE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
34521717OTHERTXAETNA
489428JOTHERTXBCBS

General Provider Information

NPI Number : 1477548618
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID MICHAEL DICK MD
Provider Business Mailing Address
First Line : 619 S FLEISHEL AVE
Second Line : SUITE 101
City : TYLER
State : TX
Zip : 75701-2004
Country : US
Telephone Number : 903-595-5514
Fax Number :
Provider Business Practice Location Address
First Line : 619 S FLEISHEL AVE
Second Line : SUITE 101
City : TYLER
State : TX
Zip : 75701-2004
Country : US
Telephone Number : 903-595-5514
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2005
Last Update Date : 04/26/2017

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