Healthcare Provider Details

I. General information

NPI: 1104448398
Provider Name (Legal Business Name): BRIAN KENNETH VADASZ MD MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date: 01/11/2022
Reactivation Date: 01/12/2022

III. Provider practice location address

251 EAST HURON STREET
CHICAGO IL
60611
US

IV. Provider business mailing address

423 E OHIO ST UNIT 204
CHICAGO IL
60611-3050
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036167262
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: