Provider Demographics
NPI:1558397299
Name:DIXIT, MEHUL P (MD DM)
Entity Type:Individual
Prefix:MR
First Name:MEHUL
Middle Name:P
Last Name:DIXIT
Suffix:
Gender:M
Credentials:MD DM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5970
Mailing Address - Fax:601-815-5902
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5970
Practice Address - Fax:601-815-5902
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME917252080P0210X, 207RN0300X
MS212282080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52242OtherBCBS
MS07933347Medicaid
FL271724700Medicaid
FL52242ZMedicare PIN
MS302I370682Medicare PIN
H07932Medicare UPIN
MS302I397245Medicare PIN