Provider Demographics
NPI:1497018493
Name:SVAZAS, BRIAN CHARLES (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CHARLES
Last Name:SVAZAS
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5324
Mailing Address - Country:US
Mailing Address - Phone:630-942-1742
Mailing Address - Fax:
Practice Address - Street 1:211 KENILWORTH AVE
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5324
Practice Address - Country:US
Practice Address - Phone:630-942-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360712742083X0100X
SC372772083X0100X
CAG620482083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA53673Medicare UPIN