Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 036.117792 | IL |
NPI | 1033315999 |
---|---|
Provider Name | Dr. Gerard L. Dysico |
First Address | Oak Forest, IL 60452-4006 |
Second Address | Oak Forest, IL 60452-4006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2007 |
Last Update Date | 23/04/2021 |