Basic Information
| Provider Information | |||||||||
| NPI: | 1699339770 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYSIAK | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | GAWEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1303 WOODEDEN DRIVE | ||||||||
| Address2: | |||||||||
| City: | MISSISSAUGA | ||||||||
| State: | ONTARIO | ||||||||
| PostalCode: | L5H2T7 | ||||||||
| CountryCode: | CA | ||||||||
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| Practice Location | |||||||||
| Address1: | 2160 S 1ST AVENUE LOYOLA UNIVERSITY MEDICAL CENTER | ||||||||
| Address2: | |||||||||
| City: | MAYWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601533328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082169169 | ||||||||
| FaxNumber: | 7082161249 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2019 | ||||||||
| LastUpdateDate: | 08/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 125075007 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.