Provider Demographics
NPI:1134275845
Name:STEIN, BRADY LEE (MD)
Entity type:Individual
Prefix:DR
First Name:BRADY
Middle Name:LEE
Last Name:STEIN
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 1:645 N MICHIGAN AVE STE 1020
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2814
Mailing Address - Country:US
Mailing Address - Phone:312-695-6832
Mailing Address - Fax:312-695-7814
Practice Address - Street 1:645 N MICHIGAN AVE STE 1020
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2814
Practice Address - Country:US
Practice Address - Phone:312-695-6832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD64644207R00000X
IL036-125922207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD014071600Medicaid
MD176929Y1JMedicare PIN