Provider Demographics
NPI:1508244153
Name:DYMINSKI, FILIP ROBERT
Entity Type:Individual
Prefix:MR
First Name:FILIP
Middle Name:ROBERT
Last Name:DYMINSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 BRISTOL DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7503
Mailing Address - Country:US
Mailing Address - Phone:815-621-5915
Mailing Address - Fax:
Practice Address - Street 1:320 BRISTOL DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7503
Practice Address - Country:US
Practice Address - Phone:815-621-5915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program