Provider Demographics
NPI:1275892176
Name:L. DIZON, M.D. P.C.
Entity Type:Organization
Organization Name:L. DIZON, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONIDES
Authorized Official - Middle Name:ARES
Authorized Official - Last Name:DIZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-626-1602
Mailing Address - Street 1:20307 W 12 MILE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5407
Mailing Address - Country:US
Mailing Address - Phone:248-354-3131
Mailing Address - Fax:248-354-3131
Practice Address - Street 1:20307 W 12 MILE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5407
Practice Address - Country:US
Practice Address - Phone:248-354-3131
Practice Address - Fax:248-354-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034833207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty