Individual
MR. MICHAEL HENRY DYKSTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.T. (R)
Contact information
Practice address
5314 BANNON CROSSINGS DR, BUECHEL, KY 40218-4023
(502) 320-7456
Mailing address
5314 BANNON CROSSINGS DR, BUECHEL, KY 40218-4023
(502) 320-7456
Taxonomy
Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
10-056-10860
KY
2471C3402X
Radiography Radiologic Technologist
Primary
473124
MN
Other
Enumeration date
11/06/2014
Last updated
11/06/2014
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