Individual
VICKIE K REZAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5645 W ADDISON ST, CHICAGO, IL 60634-4403
(773) 282-7000
Mailing address
520 E 22ND ST, LOMBARD, IL 60148-6110
(630) 960-9222
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
036061683
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01633170
BCBS IL
IL
05
—
036061683
—
IL
01
—
P00001303
RAILROAD MEDICARE
—
Enumeration date
09/15/2006
Last updated
02/09/2016
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