Healthcare Provider Details

I. General information

NPI: 1144857327
Provider Name (Legal Business Name): ALEXANDRA BALABANOV DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST 970
CHICAGO IL
60612
US

IV. Provider business mailing address

1725 W HARRISON ST STE 970
CHICAGO IL
60612-3828
US

V. Phone/Fax

Practice location:
  • Phone: 312-563-3447
  • Fax:
Mailing address:
  • Phone: 312-563-3447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number036.169788
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number036.169788
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: