Healthcare Provider Details

I. General information

NPI: 1992797120
Provider Name (Legal Business Name): VYTENIS T GRYBAUSKAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 W COLLEGE DR STE 208
PALOS HEIGHTS IL
60463-1189
US

IV. Provider business mailing address

7350 W COLLEGE DR STE 208
PALOS HEIGHTS IL
60463-1189
US

V. Phone/Fax

Practice location:
  • Phone: 708-361-9199
  • Fax: 708-361-9299
Mailing address:
  • Phone: 708-361-9199
  • Fax: 708-361-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036061531
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: