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General NPI Number Information
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NPI Number | 1841678844
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Entity Type | Individual
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Provider Name | STEFAN DYLEWSKI
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Gender | Male
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 1959 E PARIS AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-6272
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Country | US
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Telephone | 616-808-2695
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Fax |
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Provider Business Mailing Address
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Address Line | 2180 WATERVIEW DR UNIT 142
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City | NORTH MYRTLE BEACH
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State | SC
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Zip | 29582-9370
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Country | US
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Telephone | 616-821-8132
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301509420
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | LL38536
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License Number State | SC
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