Provider Demographics
NPI:1457007254
Name:VAJDIC, TYLER GEORGE
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:GEORGE
Last Name:VAJDIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 WEST HURON STREET
Mailing Address - Street 2:APARTMENT 1F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622
Mailing Address - Country:US
Mailing Address - Phone:847-504-6530
Mailing Address - Fax:
Practice Address - Street 1:1738 WEST HURON STREET
Practice Address - Street 2:APARTMENT 1F
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622
Practice Address - Country:US
Practice Address - Phone:847-504-6530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program