Healthcare Provider Details

I. General information

NPI: 1114423597
Provider Name (Legal Business Name): BAKO AGNES ORIONZI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 W DEMING PL STE 6000
CHICAGO IL
60614-1881
US

IV. Provider business mailing address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6450
  • Fax: 312-227-9441
Mailing address:
  • Phone: 312-227-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036161159
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: