MEDICARE: KYLE ANNA DYMANUS

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
1	208800000X	Urology Physician	125078970	IL
2	208800000X	Urology Physician	344586	NY

General Provider Information

NPI Number	:	1083292700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE ANNA DYMANUS

Provider Business Mailing Address
First Line	:	3530 FRANCIS LEWIS BLVD STE 201
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-1959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 FRANCIS LEWIS BLVD STE 201
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-1959
Country	:	US
Telephone Number	:	312-942-7100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2021
Last Update Date	:	06/05/2026

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Directions to “ KYLE ANNA DYMANUS ” Practice Location

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