Provider Demographics
NPI:1063254183
Name:HRVAT, ADIS
Entity type:Individual
Prefix:
First Name:ADIS
Middle Name:
Last Name:HRVAT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1853 W POLK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4355
Mailing Address - Country:US
Mailing Address - Phone:312-996-2450
Mailing Address - Fax:
Practice Address - Street 1:1875 DEMPSTER ST STE 360
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1192
Practice Address - Country:US
Practice Address - Phone:847-795-3100
Practice Address - Fax:847-723-5882
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program