MEDICARE: DUANE DICKENS 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
1	207QA0401X	Addiction Medicine (Family Medicine) Physician	35061901	OH
2	207Q00000X	Family Medicine Physician	35.061901	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1568401685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUANE DICKENS MD

Provider Business Mailing Address
First Line	:	3038 OLIVE RD
Second Line	:
City	:	TROTWOOD
State	:	OH
Zip	:	45426-2640
Country	:	US
Telephone Number	:	937-208-7050
Fax Number	:	937-208-7031

Provider Business Practice Location Address
First Line	:	3038 OLIVE RD
Second Line	:
City	:	TROTWOOD
State	:	OH
Zip	:	45426-2640
Country	:	US
Telephone Number	:	937-208-7050
Fax Number	:	937-208-7031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	12/28/2017

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Directions to “ DUANE DICKENS MD” Practice Location

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