MEDICARE: B ADRIAN KESALA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	036048737	IL
2	2085N0700X	Neuroradiology Physician	036048737	IL
3	2085N0904X	Nuclear Radiology Physician	036048737	IL
4	2085P0229X	Pediatric Radiology Physician	036048737	IL
5	2085R0202X	Diagnostic Radiology Physician	036048737	IL
6	2085R0204X	Vascular & Interventional Radiology Physician	036048737	IL
7	2085U0001X	Diagnostic Ultrasound Physician	036048737	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001619902	OTHER	IL	BLUE CROSS BLUE SHIELD-IL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578597779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	B ADRIAN KESALA M.D.

Provider Business Mailing Address
First Line	:	50 N NORTHWEST HWY
Second Line	:	# 309
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-3291
Country	:	US
Telephone Number	:	847-698-2630
Fax Number	:	847-698-0558

Provider Business Practice Location Address
First Line	:	7435 W TALCOTT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3707
Country	:	US
Telephone Number	:	773-792-5138
Fax Number	:	773-792-5124

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	12/17/2013

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