Provider Demographics
NPI:1194826511
Name:BYK, DMITRY (MD)
Entity type:Individual
Prefix:
First Name:DMITRY
Middle Name:
Last Name:BYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12515 ORANGE DR STE 801
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4309
Mailing Address - Country:US
Mailing Address - Phone:954-574-2804
Mailing Address - Fax:954-284-0182
Practice Address - Street 1:12515 ORANGE DR STE 801
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4309
Practice Address - Country:US
Practice Address - Phone:305-932-5500
Practice Address - Fax:305-935-0466
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0866852084P0800X
FLME985842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2731440Medicaid
OH2731440Medicaid