Healthcare Provider Details

I. General information

NPI: 1316955057
Provider Name (Legal Business Name): MAJA BALABAN LUKE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3134 NORTH CLARK STREET
CHICAGO IL
60673-6704
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-7032
  • Fax: 773-296-3096
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209-004809
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: