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General NPI Number Information
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NPI Number | 1306315817
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Entity Type | Individual
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Provider Name | STEPHANIE BALUKA PA
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Gender | Female
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Dates
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Enumeration Date | 11/14/2018
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 6337 S WOODLAWN AVE
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City | CHICAGO
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State | IL
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Zip | 60637-3707
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Country | US
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Telephone | 773-753-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 3620 HARRISON AVE
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City | BROOKFIELD
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State | IL
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Zip | 60513-1514
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Country | US
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Telephone | 708-701-3776
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085-006816
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License Number State | IL
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