Healthcare Provider Details

I. General information

NPI: 1477511145
Provider Name (Legal Business Name): SALEH F DYKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 E BELTLINE AVE NE STE 201
GRAND RAPIDS MI
49525-4548
US

IV. Provider business mailing address

245 STATE ST SE STE 228
GRAND RAPIDS MI
49503-4328
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-8620
  • Fax: 616-447-7674
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301066747
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: