Healthcare Provider Details

I. General information

NPI: 1881884203
Provider Name (Legal Business Name): LEONARD F DYKO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4462 BROWN HILL ROAD NE
MINERAL CITY OH
44656-9016
US

IV. Provider business mailing address

4462 BROWN HILL ROAD NE
MINERAL CITY OH
44656-9016
US

V. Phone/Fax

Practice location:
  • Phone: 330-365-2369
  • Fax:
Mailing address:
  • Phone: 330-365-2369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50-000918
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number50.000918
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: