Healthcare Provider Details

I. General information

NPI: 1326140492
Provider Name (Legal Business Name): DEANA LYN KADYK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEANA LYN SCHEMAN

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9209 PHOENIX VILLAGE PKWY
O FALLON MO
63368-4280
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 636-561-4613
  • Fax: 636-561-4610
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2007012450
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: