Provider Demographics
NPI:1588657076
Name:DICKEY, JOHN QUENITH JR (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:QUENITH
Last Name:DICKEY
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5210 HIGHLAND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1970
Mailing Address - Country:US
Mailing Address - Phone:248-625-9099
Mailing Address - Fax:248-625-4632
Practice Address - Street 1:5210 HIGHLAND RD STE 200
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1970
Practice Address - Country:US
Practice Address - Phone:248-625-9099
Practice Address - Fax:248-625-4632
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIJD009226207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F31072OtherBCBSM COMMON PROVIDER ID
MIF00492OtherHEALTH ALLIANCE PLAN
MI101601OtherCARE CHOICES
MIC4251OtherM-CARE
MI310F337240OtherBCBSM CMG
MI5630343OtherBCBSM
MI0F31072OtherBCBSM COMMON PROVIDER ID
MIF00492OtherHEALTH ALLIANCE PLAN
MIF00492Medicare UPIN
MI0P44710Medicare PIN