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Individual
ROBERT WYSOCKI
Active
Individual
ROBERT WYSOCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036-116709
IL
207XS0106X
Orthopaedic Hand Surgery Physician
036116709
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036116709
MEDICAL LICENSE
IL
05
—
036116709 2
—
IL
01
—
1633878
BCBS ILLINOIS
IL
01
—
9429369
AETNA
—
01
—
P00836808
RR MEDICARE
—
Enumeration date
08/31/2006
Last updated
05/04/2021
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