Individual
MAX ROBERT DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
3999 VENOY RD, WAYNE, MI 48184-1485
(734) 727-0440
Mailing address
15905 FOCH ST, LIVONIA, MI 48154-3485
(248) 872-9226
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
L946620
MI
Other
Enumeration date
03/11/2018
Last updated
03/11/2018
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