Healthcare Provider Details

I. General information

NPI: 1578925657
Provider Name (Legal Business Name): BRIAN C BRAJCICH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 1600
CHICAGO IL
60611-3111
US

IV. Provider business mailing address

676 N SAINT CLAIR ST FL 6
CHICAGO IL
60611-2927
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-6868
  • Fax: 312-695-2729
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036.148084
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number036148084
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: