Provider Demographics
NPI:1629057856
Name:DIXIT, DEEPAK S (MD)
Entity Type:Individual
Prefix:
First Name:DEEPAK
Middle Name:S
Last Name:DIXIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5082
Mailing Address - Country:US
Mailing Address - Phone:985-639-0171
Mailing Address - Fax:
Practice Address - Street 1:2375 GAUSE BLVD E
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4142
Practice Address - Country:US
Practice Address - Phone:985-645-9000
Practice Address - Fax:985-645-0359
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10980R207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5U868CM53OtherMEDICARE PTAN
LA1650897Medicaid
LA444405YXTQOtherMEDICARE PTAN
LAG6438OtherBLUECROSS BLUESHIELD
F94459Medicare UPIN