Provider Demographics
NPI:1154857209
Name:DICKS, MADELINE ANN (DO)
Entity type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:ANN
Last Name:DICKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W THOMAS RD # 301
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4407
Mailing Address - Country:US
Mailing Address - Phone:602-406-7765
Mailing Address - Fax:
Practice Address - Street 1:222 W THOMAS RD STE 114
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4420
Practice Address - Country:US
Practice Address - Phone:602-406-6304
Practice Address - Fax:602-406-6302
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA95301208100000X
ND19484208100000X
390200000X
AZ010088208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program