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NPI Code Detail

MEDICARE: GRAZYNA E DYMEK MD

MEDICARE: GRAZYNA E DYMEK 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 Physician109202MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861451015
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRAZYNA E DYMEK MD
Provider Business Mailing Address
First Line : 202 JOHNSON CIR
Second Line :
City : CARROLLTON
State : MO
Zip : 64633-1950
Country : US
Telephone Number : 660-542-1604
Fax Number :
Provider Business Practice Location Address
First Line : 1502 N JEFFERSON ST
Second Line :
City : CARROLLTON
State : MO
Zip : 64633-1948
Country : US
Telephone Number : 660-542-3965
Fax Number : 660-542-0336
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2006
Last Update Date : 06/07/2011

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Directions to “ GRAZYNA E DYMEK MD” Practice Location

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