Dy-Liacco, Mark
Dy-Liacco, Mark is an individual health care provider with primary practice located at 100 E Idaho St Ste 301 , Boise ID 83712-6269. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Transplant Surgery, Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Surgical Critical Care. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Dy-Liacco, Mark can be contacted via phone (208) 381-9250.Contact Information
Primary practice address
100 E Idaho St Ste 301
Boise ID 83712-6269
Phone: (208) 381-9250
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Transplant Surgery | 204F00000X | 306134 | New York |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 036-100492 | Illinois |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 0010-09358 | North Carolina |
| Allopathic & Osteopathic Physicians / Surgical Critical Care | 2086S0102X | 036-100492 | Illinois |
| Allopathic & Osteopathic Physicians / Surgical Critical Care | 2086S0102X | 306134 | New York |
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | M-16367 | Idaho |
Profile Details
| NPI number | 1366488850 |
|---|---|
| LBN Legal business name | Dy-Liacco, Mark |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 21st, 2006 |
| Last updated | Jul 7th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366488850 | NPPES |
| North Carolina | MEDICAID | 1366488850 | |
| North Carolina | Other | NCW874A | |
| North Carolina | Other | 19PD0 |
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