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NPI Code Detail

MEDICARE: MARIA BALKOURA MD SC

MEDICARE: MARIA BALKOURA MD SC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366571945
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARIA BALKOURA MD SC
Provider Business Mailing Address
First Line : 1. E. SUPERIOR ST
Second Line : SUITE 210
City : CHICAGO
State : IL
Zip : 60611-2594
Country : US
Telephone Number : 312-944-3857
Fax Number : 312-944-8404
Provider Business Practice Location Address
First Line : 1. E. SUPERIOR ST
Second Line : SUITE 210
City : CHICAGO
State : IL
Zip : 60611-2594
Country : US
Telephone Number : 312-944-3857
Fax Number : 312-944-8404
Authorized Official
Title or Position : PRESIDENT
Name : DR. MARIA H BALKOURA
Credential : M.D.
Telephone Number : 312-944-3857
Provider Enumeration Date : 03/02/2007
Last Update Date : 11/26/2007

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