MEDICARE: DIX-EUREKA MED CENTER PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	261QU0200X	Urgent Care Clinic/Center
3	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700H20090	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1750434056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIX-EUREKA MED CENTER PC

Provider Business Mailing Address
First Line	:	14797 DIX TOLEDO RD
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-2507
Country	:	US
Telephone Number	:	734-281-9950
Fax Number	:	734-281-4998

Provider Business Practice Location Address
First Line	:	14797 DIX TOLEDO RD
Second Line	:
City	:	SOUTHGATE
State	:	MI
Zip	:	48195-2507
Country	:	US
Telephone Number	:	734-281-9950
Fax Number	:	734-281-4998

Authorized Official
Title or Position	:	CEO
Name	:	DR. SITA RAM KAURA
Credential	:	MD
Telephone Number	:	734-281-9950

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	03/14/2014

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