Provider Demographics
NPI:1134183221
Name:DIXON, DONALD W (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:W
Last Name:DIXON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:19001 OLD LAGRANGE RD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8012
Mailing Address - Country:US
Mailing Address - Phone:708-478-3600
Mailing Address - Fax:708-478-3552
Practice Address - Street 1:3231 EUCLID AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3471
Practice Address - Country:US
Practice Address - Phone:708-783-2055
Practice Address - Fax:708-783-2181
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047316207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621208OtherBLUECROSS BLUE SHIELD
IL060062412OtherRAILROAD MEDICARE COOK
IL036047316Medicaid
IL236550OtherMEDICARE GROUP
IL1508810086OtherGROUP NPI
IL036047316Medicaid
IL01621208OtherBLUECROSS BLUE SHIELD