Provider Demographics
NPI:1447259148
Name:DIXIT, JAGANNATH K (MD)
Entity type:Individual
Prefix:DR
First Name:JAGANNATH
Middle Name:K
Last Name:DIXIT
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 1:8865 W 400 NO.
Mailing Address - Street 2:#115
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-9223
Mailing Address - Country:US
Mailing Address - Phone:219-872-7268
Mailing Address - Fax:219-872-2224
Practice Address - Street 1:8865 W 400 NO.
Practice Address - Street 2:#115
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9223
Practice Address - Country:US
Practice Address - Phone:219-872-7268
Practice Address - Fax:219-872-2224
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028883A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00231139OtherRAILROAD MEDICARE
IN000000363639OtherBC BS
IN200405570Medicaid
INC67681Medicare UPIN
IN200405570Medicaid
IN212080DMedicare ID - Type Unspecified