Healthcare Provider Details

I. General information

NPI: 1063657872
Provider Name (Legal Business Name): PIOTR T DYK MD - NEPHROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EDGEWATER PT STE 303
LAKE SAINT LOUIS MO
63367-2954
US

IV. Provider business mailing address

1000 EDGEWATER PT STE 303
LAKE ST LOUIS MO
63367-2954
US

V. Phone/Fax

Practice location:
  • Phone: 636-265-2225
  • Fax: 636-265-0320
Mailing address:
  • Phone: 636-265-2225
  • Fax: 636-265-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number36787
License Number StateMO

VIII. Authorized Official

Name: PIOTR DYK
Title or Position: PRESIDENT
Credential:
Phone: 636-265-2225