Individual
JOHN J MYTYCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
2120 W IRONWOOD CENTER DR, COEUR D ALENE, ID 83814-2639
(208) 625-6944
(208) 625-6945
Mailing address
280 S MAIN ST, BOUNTIFUL, UT 84010-6236
(801) 505-0821
(801) 505-0803
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
016005082
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
10140276-0501
UT
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
3271756
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10140276-0501
MEDICAL LICENSE
UT
01
—
Q00214425
RR MEDICARE
UT
01
—
U00011270
MEDICARE PTAN
UT
Enumeration date
09/25/2006
Last updated
06/17/2025
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