Individual
DR. DIXIE R MULLENNIX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5350 LAMME RD, MORAINE, OH 45439-3215
(937) 451-3123
(937) 350-6477
Mailing address
PO BOX 78000, DEPT 781267, DETROIT, MI 45278-1267
(937) 451-3123
(937) 350-6477
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-080424
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2328592
—
OH
01
—
4094751
MEDICARE PTAN
OH
Enumeration date
09/07/2005
Last updated
01/19/2018
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