Provider Demographics
NPI:1104448398
Name:VADASZ, BRIAN KENNETH (MD MSC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KENNETH
Last Name:VADASZ
Suffix:
Gender:M
Credentials:MD MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 E OHIO ST UNIT 204
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:251 EAST HURON STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-926-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2024-12-10
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2022-01-12
Provider Licenses
StateLicense IDTaxonomies
IL036167262207ZP0102X
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program