Provider Demographics
NPI:1295925071
Name:DYDYNSKI, PHILIP BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:BERNARD
Last Name:DYDYNSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-7200
Mailing Address - Fax:314-747-4189
Practice Address - Street 1:510 S KINGSHIGHWAY BLVD
Practice Address - Street 2:DEPT RADIOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1016
Practice Address - Country:US
Practice Address - Phone:314-362-7200
Practice Address - Fax:314-747-4189
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240088762085P0229X
KY441402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY125722OtherSIHO - KCR
IN201025050Medicaid
KY00057119WOtherHUMANA - KCR
KY50033000OtherPASSPORT - KCR
KY7100160570Medicaid
KY4465721OtherCIGNA - KCR
KY000000706923OtherANTHEM - KCR
LA1067237Medicaid
KY4465721OtherCIGNA - KCR