Provider Demographics
NPI:1023503885
Name:VASSILIADES, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:VASSILIADES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WEISS MEMORIAL HOSPITAL, MEDICAL EDUCATION DPT.
Mailing Address - Street 2:4646 N. MARINE DRIVE, C ELEVATORS, 7TH FLR. # 7100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640
Mailing Address - Country:US
Mailing Address - Phone:773-564-5225
Mailing Address - Fax:
Practice Address - Street 1:250 E SUPERIOR ST STE 4-2304
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-695-5753
Practice Address - Fax:312-695-5645
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125072810207R00000X
IL0361637322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine