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General NPI Number Information
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NPI Number | 1073822573
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Entity Type | Individual
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Provider Name | ALYSSA VAN DYK M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 1150 N INDIAN CANYON DR
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City | PALM SPRINGS
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State | CA
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Zip | 92262
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Country | US
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Telephone | 847-400-4252
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 S INDIANA AVE UNIT 1405
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City | CHICAGO
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State | IL
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Zip | 60616-4737
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 125-056999
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | A132809
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License Number State | CA
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