Provider Demographics
NPI:1881884203
Name:DYKO, LEONARD F (PA-C)
Entity type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:F
Last Name:DYKO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4462 BROWN HILL ROAD NE
Mailing Address - Street 2:
Mailing Address - City:MINERAL CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44656-9016
Mailing Address - Country:US
Mailing Address - Phone:330-365-2369
Mailing Address - Fax:
Practice Address - Street 1:4462 BROWN HILL ROAD NE
Practice Address - Street 2:
Practice Address - City:MINERAL CITY
Practice Address - State:OH
Practice Address - Zip Code:44656-9016
Practice Address - Country:US
Practice Address - Phone:330-365-2369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-000918363AM0700X
OH50.000918207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDYPA29163Medicare PIN