Provider Demographics
NPI:1700869708
Name:NYLK, THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:NYLK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TOMASZ
Other - Middle Name:
Other - Last Name:NYLK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5390 LONGLEY LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2291
Mailing Address - Country:US
Mailing Address - Phone:775-302-0000
Mailing Address - Fax:775-260-0368
Practice Address - Street 1:5390 LONGLEY LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2291
Practice Address - Country:US
Practice Address - Phone:775-302-0000
Practice Address - Fax:775-260-0368
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89193207RC0000X
NV12300207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
11762408OtherCAQH
CAA89193OtherMEDICAL LICENSE
NV12300OtherMEDICAL LICENSE
1700869708OtherNPI
CACA114485Medicare PIN
11762408OtherCAQH
1700869708OtherNPI