MARK J. DYKSTRA (NPI# 1083646772) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083646772 |
| Entity Type | Individual |
| Full Name | MARK J. DYKSTRA |
| Credential | M.D. |
| Practice Address |
N84w16889 Menomonee Ave Menomonee Falls WI 53051-2810 |
| Mailing Address |
3003 W Good Hope Rd Milwaukee WI 53209-2042 |
| Practice Telephone | 2622517500 |
| Practice Fax Number | 2622517128 |
| Mailing Telephone | 4143523100 |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2010-10-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 43757 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | RR MEDICARE | P00462688 | 01 |
| WI | 34132500 | 05 |
| Street Address |
N84W16889 MENOMONEE AVE |
| City | MENOMONEE FALLS |
| State | WI |
| Zip Code | 53051-2810 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942207741 | June Constantza Moldvan-jacobs | Family Medicine | N84w16889 Menomonee Ave, Menomonee Falls, WI 53051-2810 | 2005-07-07 |
| 1083224075 | Nicole B Senger | Physical Therapist | N84w16889 Menomonee Ave, Menomonee Falls, WI 53051-2810 | 2020-08-04 |
| 1609499409 | Laura Beth Westerman | Physical Therapy Assistant | N84w16889 Menomonee Ave, Menomonee Falls, WI 53051-2810 | 2020-05-27 |
| 1316595549 | Hailey Mohrfeld | Physical Medicine & Rehabilitation | N84w16889 Menomonee Ave, Menomonee Falls, WI 53051-2810 | 2019-08-30 |
| 1811557820 | Virginia Whinnery | Physician Assistant | N84w16889 Menomonee Ave, Menomonee Falls, WI 53051-2810 | 2019-06-20 |
| 1144880824 | Dominic Tomczyk | Physical Therapist | N84w16889 Menomonee Ave, Menomonee Falls, WI 53051 | 2019-06-16 |
| 1265091912 | Natalie D Stella | Nurse Practitioner | N84w16889 Menomonee Ave, Menomonee Falls, WI 53051-2810 | 2019-06-06 |
| 1437639069 | Wendy A Rousseau | Occupational Therapist | N84w16889 Menomonee Ave, Menomonee Falls, WI 53051-2810 | 2018-08-14 |
| 1720588023 | Caitlyn M Gunzel | Speech-Language Pathologist | N84w16889 Menomonee Ave, Menomonee Falls, WI 53051-2810 | 2018-02-14 |
| 1285144048 | Sarah M Hunt | Physical Therapist | N84w16889 Menomonee Ave, Menomonee Falls, WI 53051-2810 | 2017-10-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356968002 | Marisa Hiley | Nurse Practitioner | W129 N7055 Northfield Drive, Menomonee Falls, WI 53051 | 2020-06-29 |
| 1225687940 | Andres Sercovich | Pharmacist | W12501 Leatherwood Ct N74, Menomonee Falls, WI 53051 | 2019-09-05 |
| 1699329193 | Athletico Ltd | Physical Therapist | N88w15562 Main St, Menomonee Falls, WI 53051 | 2019-08-01 |
| 1386103059 | Aegis Group Practice LLC | Occupational Therapist | N48w14250 W Hampton Ave, Menomonee Falls, WI 53051 | 2019-03-13 |
| 1962969220 | Paladina Health, LLC | Family Medicine | Paladina Health Menomonee Falls, N84 W15787 Menomonee Avenue Suite 6, Menomonee Falls, WI 53051 | 2019-02-22 |
| 1053814772 | Waukesha County Community Dental Clinic, Inc. | Clinic/Center | N81w15062 Appleton Ave, Menomonee Falls, WI 53051 | 2018-03-09 |
| 1942753314 | Kelly Schmidt | Pharmacist | 200 Woodland Prime Ste 300, Menomonee Falls, WI 53051 | 2016-08-02 |
| 1386027548 | Generations Family Dental Care Menomonee Falls, LLC | Dentist | N48 W14170 Hampton Ave., Menomonee Falls, WI 53051 | 2015-07-07 |
| 1184007551 | Monjot Kaur Kang | Pharmacist | N82 W15882 Appleton Ave, Menomonee Falls, WI 53051 | 2015-07-03 |
| 1417334038 | Costco Wholesale Corporation | Hearing Aid Equipment | 9235 Pershing Avenue, Menomonee Falls, WI 53051 | 2015-05-04 |
| Find all providers in zip 53051 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598108458 | Kevin M Zeeck | Urology | N84w16889 Menomonee Ave, Menomonee Falls, WI 53051 | 2013-04-10 |
| 1770707358 | Jeffrey Paul Bejma | Urology | W129n7055 Northfield Dr, Community Memorial Medical Commons, Menomonee Falls, WI 53051-0538 | 2007-04-12 |
| 1992793327 | Michelle Andrew | Urology | W180n8000 Town Hall Rd, Urology, Menomonee Falls, WI 53051-4002 | 2005-10-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649520180 | George Leonard Apfelbach Jr. | Urology | 4098 Main St, Fish Creek, WI 54212-0067 | 2012-09-12 |
| 1346505708 | Kenneth Lowell Day | Urology | 2603 Teal Ave (residence), Wausau, WI 54401-7162 | 2012-07-11 |
| 1356601587 | Fox Valley Urological Associates Sc | Urology | 2700 E Enterprise Ave Ste A, Appleton, WI 54913-7656 | 2012-05-22 |
| 1730445255 | Anand Patel | Urology | 2424 S 90th St Fl 3, West Allis, WI 53227-2455 | 2012-04-10 |
| 1831486117 | Mary Hallman Leikness | Urology | 358 S. Oxford Street, Pob 207, Wautoma, WI 54982-0000 | 2011-07-07 |
| 1710293105 | Charles Copland Smith | Urology | 674 Sunset Circle, Green Bay, WI 54301 | 2010-08-24 |
| 1689991200 | Sean Brady Mcadams | Urology | 720 S Vanburen Street, Suite 301, Green Bay, WI 54301 | 2010-04-21 |
| 1730404385 | Robert J Hartman Jr. | Urology | 10400 75th St Ste 204, Kenosha, WI 53142-7884 | 2010-04-06 |
| 1588998538 | Gary Melvin Licklider | Urology | 5002 Prairie Rose Ct, Middleton, WI 53562-2385 | 2009-09-23 |
| 1376793240 | Raymond Harkavy | Urology | 9440 N. Broadmoor Road, Milwaukee, WI 53217-1309 | 2008-09-26 |
| Find all providers with the same taxonomy | ||||
| City | MENOMONEE FALLS |
| Zip Code | 53051 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.