MEDICARE: MR. MOR BEN BARAK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	125058326	IL
2	207L00000X	Anesthesiology Physician	036138016	IL

General Provider Information

NPI Number	:	1245541374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MOR BEN BARAK M.D.

Provider Business Mailing Address
First Line	:	5616 N WINTHROP AVE APT 1F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-4420
Country	:	US
Telephone Number	:	708-691-7706
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 E SUPERIOR ST FL 12
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-4494
Country	:	US
Telephone Number	:	312-503-7975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	09/30/2020

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