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General NPI Number Information
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NPI Number | 1568790376
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Entity Type | Organization
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Legal Business Name | DK CONSULTANTS LLC
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Dates
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Enumeration Date | 12/07/2009
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Last Update Date | 12/07/2009
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Provider Practice Location Address
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Address Line | 145 DURHAM RD BOX 7 SUITE 10
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City | MADISON
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State | CT
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Zip | 06443-2674
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Country | US
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Telephone | 203-318-8486
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Fax | 203-404-4934
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Provider Business Mailing Address
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Address Line | 145 DURHAM RD BOX 7 SUITE 10
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City | MADISON
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State | CT
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Zip | 06443-2674
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Country | US
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Telephone | 203-318-8486
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Fax | 203-404-4934
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES C DIKE
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Credential | M.D
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Telephone | 203-318-8486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 039301
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License Number State | CT
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