MEDICARE: MR. LEONARD F DYKO 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	363AM0700X	Medical Physician Assistant	50-000918	OH
2	207P00000X	Emergency Medicine Physician	50.000918	OH

General Provider Information

NPI Number	:	1881884203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEONARD F DYKO PA-C

Provider Business Mailing Address
First Line	:	4462 BROWN HILL ROAD NE
Second Line	:
City	:	MINERAL CITY
State	:	OH
Zip	:	44656-9016
Country	:	US
Telephone Number	:	330-365-2369
Fax Number	:

Provider Business Practice Location Address
First Line	:	4462 BROWN HILL ROAD NE
Second Line	:
City	:	MINERAL CITY
State	:	OH
Zip	:	44656-9016
Country	:	US
Telephone Number	:	330-365-2369
Fax Number	:

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

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	03/20/2012

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