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General NPI Number Information
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NPI Number | 1235619065
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Entity Type | Organization
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Legal Business Name | BILLY R NORDYKE JR DO PC
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 05/31/2019
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Provider Practice Location Address
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Address Line | 2201 FORD AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-2314
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Country | US
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Telephone | 734-258-8835
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Fax | 734-258-8885
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Provider Business Mailing Address
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Address Line | 2201 FORD AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-2314
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Country | US
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Telephone | 734-258-8835
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Fax | 734-258-8885
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Authorized Official
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Title or Position | DO/CEO
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Name | DR. BILLY RALPH NORDYKE
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Credential | DO
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Telephone | 734-758-8835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101018163
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License Number State | MI
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