Individual
THEODORE M WYNNYCHENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2650 RIDGE AVE, DEPARTMENT OF ANESTHESIA, EVANSTON, IL 60201
(847) 570-2760
(847) 570-2921
Mailing address
450 W IL ROUTE 22 DEPT OF, BARRINGTON, IL 60010-1919
(847) 381-0123
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036100119
IL
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
036100119
IL
207LP3000X
Pediatric Anesthesiology Physician
036100119
IL
Other
Enumeration date
06/20/2006
Last updated
12/29/2021
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