Healthcare Provider Details

I. General information

NPI: 1235134727
Provider Name (Legal Business Name): BRAD ANSTADT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W NORTH AVE STE 107
MELROSE PARK IL
60160-1622
US

IV. Provider business mailing address

675 W NORTH AVE STE 107
MELROSE PARK IL
60160-1622
US

V. Phone/Fax

Practice location:
  • Phone: 708-450-4510
  • Fax: 708-450-9361
Mailing address:
  • Phone: 708-450-4510
  • Fax: 708-450-9361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036065303
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: