Healthcare Provider Details

I. General information

NPI: 1841678844
Provider Name (Legal Business Name): STEFAN DYLEWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 E PARIS AVE SE
GRAND RAPIDS MI
49546-6272
US

IV. Provider business mailing address

2180 WATERVIEW DR UNIT 142
NORTH MYRTLE BEACH SC
29582-9370
US

V. Phone/Fax

Practice location:
  • Phone: 616-808-2695
  • Fax:
Mailing address:
  • Phone: 616-821-8132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301509420
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLL38536
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: