Provider Demographics
NPI:1982643359
Name:DIXON, GEOFFREY R (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:R
Last Name:DIXON
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 1:1200 S YORK RD
Mailing Address - Street 2:SUITE 4280
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5626
Mailing Address - Country:US
Mailing Address - Phone:331-462-1700
Mailing Address - Fax:630-758-8881
Practice Address - Street 1:1200 S YORK RD
Practice Address - Street 2:SUITE 4280
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5626
Practice Address - Country:US
Practice Address - Phone:331-462-1700
Practice Address - Fax:630-758-8881
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010564204A207T00000X
IL036109252207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200371910Medicaid
IN129164100OtherINDIANA DEPT OF LABOR
IN140008059OtherPALMETTO RR MEDICARE
IN0227992OtherANTHEM
IL209226007Medicare PIN
IN200371910Medicaid
IN129164100OtherINDIANA DEPT OF LABOR
IN140008059OtherPALMETTO RR MEDICARE