Healthcare Provider Details

I. General information

NPI: 1215598024
Provider Name (Legal Business Name): DANIEL BALIKOV MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 08/28/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4822 S COTTAGE GROVE AVE STE 2-300
CHICAGO IL
60061
US

IV. Provider business mailing address

4822 S COTTAGE GROVE AVE STE 2-300
CHICAGO IL
60061
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8150
  • Fax: 312-921-1071
Mailing address:
  • Phone: 312-695-8150
  • Fax: 312-921-1071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME161907
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number036176089
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: