Provider Demographics
NPI:1730192410
Name:DIXON, MELINDA ANNA (MD)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:ANNA
Last Name:DIXON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:ANNA
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18464 SALEM
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219
Mailing Address - Country:US
Mailing Address - Phone:313-533-7151
Mailing Address - Fax:
Practice Address - Street 1:1151 TAYLOR STREET
Practice Address - Street 2:DETROIT HEALTH DEPT HERMAN KIEFER HEALTH COMPLEX
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1732
Practice Address - Country:US
Practice Address - Phone:313-876-4720
Practice Address - Fax:313-876-0070
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11563449OtherCAQH
MI4406167Medicaid
MIH26164130Medicare ID - Type Unspecified