Provider Demographics
NPI:1407944325
Name:ROMAN J. DYKUN, MD
Entity Type:Organization
Organization Name:ROMAN J. DYKUN, MD
Other - Org Name:AFFILIATED EAR, NOSE AND THROAT PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-338-4600
Mailing Address - Street 1:2441 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-6911
Mailing Address - Country:US
Mailing Address - Phone:815-338-4600
Mailing Address - Fax:815-338-4611
Practice Address - Street 1:2441 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-6911
Practice Address - Country:US
Practice Address - Phone:815-338-4600
Practice Address - Fax:815-338-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05620247OtherBCBS
IL5632066OtherBC/BS
IL5632066OtherBC/BS
IL05620247OtherBCBS
ILCN5830Medicare PIN
IL5632066OtherBC/BS