Provider Demographics
NPI:1255320883
Name:DIXIT, DEEPA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPA
Middle Name:
Last Name:DIXIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37300 GARFIELD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2051
Mailing Address - Country:US
Mailing Address - Phone:586-286-0550
Mailing Address - Fax:586-263-0735
Practice Address - Street 1:37300 GARFIELD RD
Practice Address - Street 2:SUITE B
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-2051
Practice Address - Country:US
Practice Address - Phone:586-286-0550
Practice Address - Fax:586-263-0735
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDD041485207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0305014821OtherBLUE CROSS BLUE SHIELD MI
MI861098320OtherCIGNA
MI861098320OtherAETNA
MIA74697OtherHEALTH ALLIANCE PLAN MI
MI1765213Medicaid
MIP101616OtherPREFERRED/CARE CHOICES
MI0305014821OtherBLUE CROSS BLUE SHIELD MI
MIA74697OtherHEALTH ALLIANCE PLAN MI