Basic Information
| Provider Information | |||||||||
| NPI: | 1487635637 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DYKOWSKI | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35046 WOODWARD AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480090932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486479860 | ||||||||
| FaxNumber: | 2486479864 | ||||||||
| Practice Location | |||||||||
| Address1: | 35046 WOODWARD AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480090932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486479860 | ||||||||
| FaxNumber: | 2486479864 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 07/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4301047674 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.