Healthcare Provider Details

I. General information

NPI: 1235136151
Provider Name (Legal Business Name): MARK RICHARD DYLEWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12575 SW 60TH CT
PINECREST FL
33156-5607
US

IV. Provider business mailing address

PO BOX 431341
MIAMI FL
33243-1341
US

V. Phone/Fax

Practice location:
  • Phone: 305-278-9906
  • Fax:
Mailing address:
  • Phone: 305-663-5864
  • Fax: 305-663-9778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberME81351
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME81351
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: