Provider Demographics
NPI:1861418204
Name:ROBERT B. WYKO, D.O.,P.A.
Entity type:Organization
Organization Name:ROBERT B. WYKO, D.O.,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:WYKO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-733-7922
Mailing Address - Street 1:1022 MAIN ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-5238
Mailing Address - Country:US
Mailing Address - Phone:727-733-7922
Mailing Address - Fax:727-738-6205
Practice Address - Street 1:1022 MAIN ST
Practice Address - Street 2:SUITE M
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5238
Practice Address - Country:US
Practice Address - Phone:727-733-7922
Practice Address - Fax:727-738-6205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3673208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010065622OtherRAILROAD MEDICARE
FL0105064OtherUHC
FL211531OtherAVMED
FL0100584OtherEVERCARE
FL5352090OtherAETNA
FL0105094OtherUHC
FL043870OtherONE HEALTH
FL2160821OtherAETNA
FL1679215OtherCIGNA
FL0105064OtherUHC
FLK3399Medicare PIN