Individual
ROBERT WYSOCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1611 W HARRISON ST, STE 400, CHICAGO, IL 60612-3841
(312) 243-4244
(312) 942-1517
Mailing address
1 WESTBROOK CORPORATE CTR, # 240, WESTCHESTER, IL 60154-5701
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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