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General NPI Number Information
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NPI Number | 1063657872
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Entity Type | Organization
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Legal Business Name | PIOTR T DYK MD - NEPHROLOGY PC
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Dates
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Enumeration Date | 12/08/2008
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 1000 EDGEWATER PT STE 303
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City | LAKE SAINT LOUIS
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State | MO
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Zip | 63367-2954
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Country | US
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Telephone | 636-265-2225
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Fax | 636-265-0320
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Provider Business Mailing Address
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Address Line | 1000 EDGEWATER PT STE 303
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-2954
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Country | US
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Telephone | 636-265-2225
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Fax | 636-265-0320
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Authorized Official
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Title or Position | PRESIDENT
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Name | PIOTR DYK
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Credential |
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Telephone | 636-265-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 36787
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License Number State | MO
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