MEDICARE: DR. GERARD L. DYSICO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	036.117792	IL

General Provider Information

NPI Number	:	1033315999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARD L. DYSICO M.D.

Provider Business Mailing Address
First Line	:	15900 SOUTH CICERO AVENUE
Second Line	:	DEPARTMENT OF REHABILITATION SERVICES
City	:	OAK FOREST
State	:	IL
Zip	:	60452-4006
Country	:	US
Telephone Number	:	708-633-3091
Fax Number	:	708-633-2006

Provider Business Practice Location Address
First Line	:	15900 SOUTH CICERO AVENUE
Second Line	:	DEPARTMENT OF REHABILITATION SERVICES
City	:	OAK FOREST
State	:	IL
Zip	:	60452-4006
Country	:	US
Telephone Number	:	708-633-3091
Fax Number	:	708-633-2006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	04/23/2021

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