Provider Demographics
NPI:1992797120
Name:GRYBAUSKAS, VYTENIS T (MD)
Entity type:Individual
Prefix:DR
First Name:VYTENIS
Middle Name:T
Last Name:GRYBAUSKAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7350 W COLLEGE DR STE 208
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1189
Mailing Address - Country:US
Mailing Address - Phone:708-361-9199
Mailing Address - Fax:708-361-9299
Practice Address - Street 1:7350 W COLLEGE DR STE 208
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1189
Practice Address - Country:US
Practice Address - Phone:708-361-9199
Practice Address - Fax:708-361-9299
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061531207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC43087Medicare UPIN
ILP00144284Medicare PIN
ILK07836Medicare PIN