Dykstra, Mark J.
Dykstra, Mark J. is an individual health care provider with primary practice located at N84W16889 Menomonee Ave , Menomonee Falls WI 53051-2810. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Dykstra, Mark J. can be contacted via phone (262) 251-7500.Contact Information
Primary practice address
N84W16889 Menomonee Ave
Menomonee Falls WI 53051-2810
Phone: (262) 251-7500
Fax: (262) 251-7128
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Urology | 208800000X | 43757 | Wisconsin |
Profile Details
| NPI number | 1083646772 |
|---|---|
| LBN Legal business name | Dykstra, Mark J. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 6th, 2006 |
| Last updated | Dec 2nd, 2021 - about 3 years ago |
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 | 1083646772 | NPPES |
| Wisconsin | MEDICAID | 34132500 | |
| Wisconsin | Other | P00462688 |
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