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General NPI Number Information
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NPI Number | 1326183989
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Entity Type | Individual
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Provider Name | SAMUEL DYKA
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 10/18/2017
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Provider Practice Location Address
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Address Line | 190 E STATE ST
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City | MONTROSE
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State | MI
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Zip | 48457-9144
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Country | US
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Telephone | 810-639-2056
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Fax |
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Provider Business Mailing Address
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Address Line | 7070 MILLER RD STE A
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City | SWARTZ CREEK
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State | MI
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Zip | 48473-1591
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Country | US
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Telephone | 810-639-2056
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601001746
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License Number State | MI
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