Provider Demographics
NPI:1063657872
Name:PIOTR T DYK MD - NEPHROLOGY PC
Entity type:Organization
Organization Name:PIOTR T DYK MD - NEPHROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PIOTR
Authorized Official - Middle Name:
Authorized Official - Last Name:DYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-265-2225
Mailing Address - Street 1:1000 EDGEWATER PT STE 303
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-2954
Mailing Address - Country:US
Mailing Address - Phone:636-265-2225
Mailing Address - Fax:636-265-0320
Practice Address - Street 1:1000 EDGEWATER PT STE 303
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-2954
Practice Address - Country:US
Practice Address - Phone:636-265-2225
Practice Address - Fax:636-265-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36787207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203554118Medicaid
MO000003798Medicare PIN
MOE58136Medicare UPIN