Provider Demographics
NPI:1063657872
Name:PIOTR T DYK MD - NEPHROLOGY PC
Entity Type:Organization
Organization Name:PIOTR T DYK MD - NEPHROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PIOTR
Authorized Official - Middle Name:T
Authorized Official - Last Name:DYK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-928-0078
Mailing Address - Street 1:140 JUNGERMANN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1698
Mailing Address - Country:US
Mailing Address - Phone:636-928-0078
Mailing Address - Fax:636-928-0089
Practice Address - Street 1:330 1ST CAPITOL DR
Practice Address - Street 2:SUITE 240
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2835
Practice Address - Country:US
Practice Address - Phone:636-443-2440
Practice Address - Fax:636-443-2486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36787207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203554118Medicaid
MO000003798Medicare PIN
MOE58136Medicare UPIN