Individual
DR. VIDA R KASUBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8420 W BRYN MAWR AVE STE 300, CHICAGO, IL 60631-3436
(708) 831-8282
(773) 714-1229
Mailing address
PO BOX 443, BEDFORD PARK, IL 60499-0443
(708) 831-8282
(773) 714-1229
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD047052L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1430768
—
PA
Enumeration date
09/21/2005
Last updated
07/13/2021
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