MEDICARE: DR. GEORGE DYCK M.D.

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	2084P0800X	Psychiatry Physician	04-15415	KS
2	2084P0805X	Geriatric Psychiatry Physician	04-15415	KS

General Provider Information

NPI Number	:	1245280437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE DYCK M.D.

Provider Business Mailing Address
First Line	:	43 LAKEWOOD CIR
Second Line	:
City	:	NORTH NEWTON
State	:	KS
Zip	:	67117-8104
Country	:	US
Telephone Number	:	316-283-7774
Fax Number	:

Provider Business Practice Location Address
First Line	:	43 LAKEWOOD CIR
Second Line	:
City	:	NORTH NEWTON
State	:	KS
Zip	:	67117-8104
Country	:	US
Telephone Number	:	316-283-7774
Fax Number	:

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	05/01/2009

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