MEDICARE: DEEPAK S. DIXIT M.D.

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	207P00000X	Emergency Medicine Physician	10980R	LA
2	207R00000X	Internal Medicine Physician	10980R	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5U868CM53	OTHER	LA	MEDICARE PTAN
3	444405YXTQ	OTHER	LA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	G6438	OTHER	LA	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1629057856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEPAK S. DIXIT M.D.

Provider Business Mailing Address
First Line	:	1237 BLUFF DR
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70461-5082
Country	:	US
Telephone Number	:	985-639-0171
Fax Number	:

Provider Business Practice Location Address
First Line	:	2375 GAUSE BLVD E
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70461-4142
Country	:	US
Telephone Number	:	985-645-9000
Fax Number	:	985-645-0359

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

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	01/12/2016

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Directions to “ DEEPAK S. DIXIT M.D.” Practice Location

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