Provider Demographics
NPI:1760684161
Name:RYBICKI, WITOLD (MD)
Entity Type:Individual
Prefix:
First Name:WITOLD
Middle Name:
Last Name:RYBICKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 TWIN LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704
Mailing Address - Country:US
Mailing Address - Phone:309-829-5566
Mailing Address - Fax:309-827-3705
Practice Address - Street 1:107 TREMONT
Practice Address - Street 2:HOPEDALE MEDICAL COMPLEX
Practice Address - City:HOPEDALE
Practice Address - State:IL
Practice Address - Zip Code:61747
Practice Address - Country:US
Practice Address - Phone:309-449-3321
Practice Address - Fax:309-449-5441
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
L82228OtherPIN
C42450Medicare UPIN
L82228OtherPIN