MEDICARE: MICHAEL VAN DYKE PA-C

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	363A00000X	Physician Assistant	PA12445	CA

General Provider Information

NPI Number	:	1659578383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL VAN DYKE PA-C

Provider Business Mailing Address
First Line	:	142 RENZ LN
Second Line	:
City	:	GEYSERVILLE
State	:	CA
Zip	:	95441-9581
Country	:	US
Telephone Number	:	707-857-4708
Fax Number	:	707-857-4723

Provider Business Practice Location Address
First Line	:	275 HOSPITAL DR
Second Line	:
City	:	UKIAH
State	:	CA
Zip	:	95482-4531
Country	:	US
Telephone Number	:	707-462-7900
Fax Number	:	707-462-7947

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	03/15/2026

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