Healthcare Provider Details

I. General information

NPI: 1578791000
Provider Name (Legal Business Name): PAWEL TADEUSZ DYK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 N BALLAS RD ONCOLOGY SUITE
SAINT LOUIS MO
63131-2329
US

IV. Provider business mailing address

3015 N BALLAS RD ONCOLOGY SUITE
SAINT LOUIS MO
63131-2329
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-5729
  • Fax:
Mailing address:
  • Phone: 314-996-5729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2014007075
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: