Individual
MARK J. DYKSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
N84W16889 MENOMONEE AVE, MENOMONEE FALLS, WI 53051-2810
(262) 251-7500
(262) 251-7128
Mailing address
3003 W GOOD HOPE RD, MILWAUKEE, WI 53209-2042
(414) 352-3100
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
43757
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34132500
—
WI
01
—
P00462688
RR MEDICARE
WI
Enumeration date
07/06/2006
Last updated
12/02/2021
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