Provider Demographics
NPI:1104080191
Name:DANIEL J. DYMEK MDPC
Entity type:Organization
Organization Name:DANIEL J. DYMEK MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DYMEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:989-790-7990
Mailing Address - Street 1:4801 MCLEOD DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604
Mailing Address - Country:UM
Mailing Address - Phone:989-790-7990
Mailing Address - Fax:
Practice Address - Street 1:4801 MCLEOD DR E
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2840
Practice Address - Country:US
Practice Address - Phone:989-790-7990
Practice Address - Fax:989-790-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDD038477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2840223Medicaid