Healthcare Provider Details

I. General information

NPI: 1154602480
Provider Name (Legal Business Name): HALUK ALIBAZOGLU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E NORTH WATER ST UNIT 3102
CHICAGO IL
60611-0814
US

IV. Provider business mailing address

340 E NORTH WATER ST UNIT 3102
CHICAGO IL
60611-0814
US

V. Phone/Fax

Practice location:
  • Phone: 312-213-4615
  • Fax:
Mailing address:
  • Phone: 312-213-4615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number06355
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number036108226
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: