Dylan Mikel Pavka, AT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2601002540 Issued in MI

Practice address

210 Sports Dr
Big Rapids, MI 49307-2715

Phone

(989) 494-8594

NPI assigned

Jul 13, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1124752332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 SPORTS DR",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493072715",
            "telephone_number": "989-494-8594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 SPORTS DR",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493072715",
            "telephone_number": "989-494-8594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAVKA",
        "first_name": "DYLAN",
        "middle_name": "MIKEL",
        "credential": "AT, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-13",
        "last_updated": "2022-07-13",
        "certification_date": "2020-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MI",
            "license": "2601002540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chris Paholak, CADC
• Smita V Pai
• Anna Lucille Palmquist, LLPC
• Nicholas Pappas, PHD, LPC
• Matthew Parrish
• Pediatric Associates of Big Rapids, P.C.
• Rachel Skye Perkins, L.M.S.W.
• Erick K Perroud, DDS
• Peter S. Vandemark, MD, PC
• Peter Zadvinskis MD PC

• Athletic Trainer in Big Rapids, MI
• Providers in Big Rapids, MI by specialty
• Athletic Trainer in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.