MEDICARE: ADRIENNE M BALSAM MD

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	2084P0800X	Psychiatry Physician	036087777	IL

General Provider Information

NPI Number	:	1285684365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE M BALSAM MD

Provider Business Mailing Address
First Line	:	4711 GOLF ROAD
Second Line	:	SUITE 1200
City	:	SKOKIE
State	:	IL
Zip	:	60076
Country	:	US
Telephone Number	:	847-933-0455
Fax Number	:	847-679-8002

Provider Business Practice Location Address
First Line	:	4711 GOLF RD STE 1200
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-1200
Country	:	US
Telephone Number	:	847-933-0455
Fax Number	:	847-679-8002

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	03/17/2018

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