Individual
DR. MICHAEL PHILIP DICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3898 NEW VISION DR, FORT WAYNE, IN 46845
(260) 425-5750
(260) 425-5755
Mailing address
3702 NEW VISION DR BLDG B, FORT WAYNE, IN 46845-1703
(260) 266-6013
(260) 458-5831
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01041905
IN
2080P0208X
Pediatric Infectious Diseases Physician
01041905
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100460690
—
IN
05
—
2024786
—
OH
Enumeration date
07/19/2006
Last updated
05/23/2018
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