Provider Demographics
NPI:1285793364
Name:NIXON, MICHAEL ALBERT (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALBERT
Last Name:NIXON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0S574 REBECCA LN
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1500
Mailing Address - Country:US
Mailing Address - Phone:630-665-1834
Mailing Address - Fax:630-665-1835
Practice Address - Street 1:0N025 WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1237
Practice Address - Country:US
Practice Address - Phone:630-933-4240
Practice Address - Fax:630-933-2675
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
K02048OtherMPIN
E15480Medicare UPIN