=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174864995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DMITRY BYK MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2013
-----------------------------------------------------
Last Update Date | 07/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12515 ORANGE DR STE 801
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33330-4309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-574-2804
-----------------------------------------------------
Fax | 954-284-0182
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12515 ORANGE DR STE 801
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33330-4309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-574-2804
-----------------------------------------------------
Fax | 954-284-0182
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DMITRY BYK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 954-574-2804
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | ME98584
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------