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NPI Code Detail

MEDICARE: RANDALL L DYK MD

MEDICARE: RANDALL L DYK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician4301076181MI

General Provider Information

NPI Number : 1033199674
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDALL L DYK MD
Provider Business Mailing Address
First Line : 670 MALL DR
Second Line :
City : PORTAGE
State : MI
Zip : 49024-2878
Country : US
Telephone Number : 269-350-8434
Fax Number : 269-350-8434
Provider Business Practice Location Address
First Line : 670 MALL DR
Second Line :
City : PORTAGE
State : MI
Zip : 49024-2878
Country : US
Telephone Number : 269-491-3263
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2006
Last Update Date : 09/29/2025

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Directions to “ RANDALL L DYK MD” Practice Location

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