Provider Demographics
NPI:1861417966
Name:DIXON, JULIE K (DO)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:K
Last Name:DIXON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2100
Mailing Address - Country:US
Mailing Address - Phone:231-398-6630
Mailing Address - Fax:231-723-8761
Practice Address - Street 1:310 9TH ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-2100
Practice Address - Country:US
Practice Address - Phone:231-398-6630
Practice Address - Fax:231-723-8761
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE26051Medicare UPIN