Healthcare Provider Details

I. General information

NPI: 1053384636
Provider Name (Legal Business Name): PAUL DYKEMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 S WASHINGTON AVE
HOLLAND MI
49423-7725
US

IV. Provider business mailing address

A-6341 145TH AVE
HOLLAND MI
49423-8978
US

V. Phone/Fax

Practice location:
  • Phone: 616-393-0166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301025812
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: