Healthcare Provider Details

I. General information

NPI: 1639299977
Provider Name (Legal Business Name): JOHN EDWARD DYBIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 N CALIFORNIA AVE SUITE 780
CHICAGO IL
60625-3645
US

IV. Provider business mailing address

5140 N CALIFORNIA AVE SUITE 780
CHICAGO IL
60625-3645
US

V. Phone/Fax

Practice location:
  • Phone: 773-273-6810
  • Fax: 773-273-5332
Mailing address:
  • Phone: 773-273-6810
  • Fax: 773-273-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036114053
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: