Provider Demographics
NPI:1033134176
Name:DYKO, BRIAN G (CNP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:G
Last Name:DYKO
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-250-0325
Mailing Address - Fax:440-250-0467
Practice Address - Street 1:29101 HEALTH CAMPUS DR BLDG 2
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5270
Practice Address - Country:US
Practice Address - Phone:440-250-0325
Practice Address - Fax:440-250-0467
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP05430363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2532969Medicaid
OHDYNP17622Medicare PIN
OHQ33871Medicare UPIN