Provider Demographics
NPI:1497259386
Name:EKSTRAND, DYLAN LOUIS (DO)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:LOUIS
Last Name:EKSTRAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 AMANDA NORTHERN RD SW
Mailing Address - Street 2:
Mailing Address - City:AMANDA
Mailing Address - State:OH
Mailing Address - Zip Code:43102-9332
Mailing Address - Country:US
Mailing Address - Phone:740-969-4828
Mailing Address - Fax:740-969-4818
Practice Address - Street 1:5115 AMANDA NORTHERN RD SW
Practice Address - Street 2:
Practice Address - City:AMANDA
Practice Address - State:OH
Practice Address - Zip Code:43102-9332
Practice Address - Country:US
Practice Address - Phone:740-969-4828
Practice Address - Fax:740-969-4818
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.030046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine