Provider Demographics
NPI:1578597779
Name:KESALA, B ADRIAN (MD)
Entity Type:Individual
Prefix:
First Name:B
Middle Name:ADRIAN
Last Name:KESALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 N NORTHWEST HWY
Mailing Address - Street 2:# 309
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3291
Mailing Address - Country:US
Mailing Address - Phone:847-698-2630
Mailing Address - Fax:847-698-0558
Practice Address - Street 1:7435 W TALCOTT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3707
Practice Address - Country:US
Practice Address - Phone:773-792-5138
Practice Address - Fax:773-792-5124
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360487372085B0100X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0202X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001619902OtherBLUE CROSS BLUE SHIELD-IL
IL036048737-3Medicaid
IL0001619902OtherBLUE CROSS BLUE SHIELD-IL
ILL36533Medicare PIN
IL036048737-3Medicaid