Provider Demographics
NPI:1306829684
Name:DYMEK, MAKSYM STEFAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAKSYM
Middle Name:STEFAN
Last Name:DYMEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1873 S BELLAIRE ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4358
Mailing Address - Country:US
Mailing Address - Phone:303-753-1191
Mailing Address - Fax:303-753-6636
Practice Address - Street 1:8300 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6005
Practice Address - Country:US
Practice Address - Phone:303-425-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME913362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00729422Medicare PIN
COP00729426Medicare PIN
CO369260YLQ8Medicare PIN
FLI25131Medicare UPIN
COP00729430Medicare PIN
COCO304727Medicare PIN
COCO304728Medicare PIN
COCO304726Medicare PIN
IN01069778AOtherLICENSE
INM400050933Medicare UPIN
CO85623067Medicaid