Provider Demographics
NPI:1043283807
Name:RADOMSKA, HELENA M (MD)
Entity Type:Individual
Prefix:DR
First Name:HELENA
Middle Name:M
Last Name:RADOMSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N MICHIGAN AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3754
Mailing Address - Country:US
Mailing Address - Phone:312-307-4160
Mailing Address - Fax:877-807-8997
Practice Address - Street 1:500 N MICHIGAN AVE STE 600
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-307-4160
Practice Address - Fax:877-807-8997
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361109002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110900Medicaid
IL212436Medicare ID - Type Unspecified
I06694Medicare UPIN