# ROBERT WYSOCKI

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1275645319
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 036-116709 | IL | Yes |
| 207XS0106X | Orthopaedic Hand Surgery Physician | 036116709 | IL | — |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 05/04/2021

## 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 | — |