Provider Demographics
NPI:1720016306
Name:RYDZYNSKI, ROBB V (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBB
Middle Name:V
Last Name:RYDZYNSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E 1ST ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-3166
Mailing Address - Country:US
Mailing Address - Phone:815-288-7711
Mailing Address - Fax:815-285-8930
Practice Address - Street 1:215 E. 1ST STREET
Practice Address - Street 2:SUITE 215
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021
Practice Address - Country:US
Practice Address - Phone:815-288-7711
Practice Address - Fax:815-285-8930
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116183207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116183Medicaid
ILK29795OtherMEDICARE
IL036-116183OtherLICENSE NUMBER