Individual
CHRISTINE DICKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1000 HARRINGTON ST, MOUNT CLEMENS, MI 48043-2920
(734) 677-7400
(734) 677-1603
Mailing address
3601 W 13 MILE RD, 400-FSC/PCS, ROYAL OAK, MI 48073-6712
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
4301060673
MI
2085R0202X
Diagnostic Radiology Physician
Primary
4301060673
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3445124
—
MI
01
—
CI8050
MEDICARE RR GROUP PIN
MI
Enumeration date
03/20/2006
Last updated
11/09/2007
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