Provider Demographics
NPI:1063686848
Name:PICKERING, DACIA AURELIA (MD)
Entity Type:Individual
Prefix:
First Name:DACIA
Middle Name:AURELIA
Last Name:PICKERING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 78866
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53278-8866
Mailing Address - Country:US
Mailing Address - Phone:779-696-7150
Mailing Address - Fax:
Practice Address - Street 1:5668 E STATE ST
Practice Address - Street 2:#2
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2490
Practice Address - Country:US
Practice Address - Phone:815-397-7900
Practice Address - Fax:815-397-4839
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036131817208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery