Provider Demographics
NPI:1790774313
Name:DIXIT, VIJAY K (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:K
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 1:37300 GARFIELD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2051
Mailing Address - Country:US
Mailing Address - Phone:586-263-9770
Mailing Address - Fax:586-263-0735
Practice Address - Street 1:37300 GARFIELD RD
Practice Address - Street 2:SUITE A
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-2051
Practice Address - Country:US
Practice Address - Phone:586-263-9770
Practice Address - Fax:586-263-0735
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIVD039924208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2591164Medicaid
MI2405000462OtherBLUE CROSS BLUE SHIELD MI
MI2591164Medicaid
MI0500046Medicare ID - Type Unspecified