Individual
MARK DIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
85 E US HIGHWAY 6 STE 300, VALPARAISO, IN 46383-8948
(219) 983-6300
(219) 983-6080
Mailing address
85 E US HIGHWAY 6 STE 300, VALPARAISO, IN 46383-8948
(219) 983-6300
(219) 983-6080
Taxonomy
Speciality
Code
Description
License number
State
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
02001376
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000497635
BLUE CROSS BLUE SHIELD IN
—
05
—
100327820
—
IN
01
—
90000561
BLUE SHIELD OF IL
—
01
—
P00386127
RAILROAD MEDICARE
—
Enumeration date
11/21/2005
Last updated
09/10/2020
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