MEDICARE: DR. MARK JAY BAILIN M.D.

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
1	208D00000X	General Practice Physician	036-069-383	IL
2	2083X0100X	Occupational Medicine Physician	036-069-383	IL
3	207P00000X	Emergency Medicine Physician	036-069-383	IL
4	208M00000X	Hospitalist Physician	036-069-383	IL
5	208VP0014X	Interventional Pain Medicine Physician	036069383	IL
6	207QA0505X	Adult Medicine Physician	036069383	IL

General Provider Information

NPI Number	:	1609068402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK JAY BAILIN M.D.

Provider Business Mailing Address
First Line	:	6238 N MAGNOLIA AV.
Second Line	:	GARDEN OR BASEMENT APT.
City	:	CHICAGO
State	:	IL
Zip	:	60660-1945
Country	:	US
Telephone Number	:	773-262-2647
Fax Number	:	773-262-2647

Provider Business Practice Location Address
First Line	:	6238 N MAGNOLIA AV.
Second Line	:	GARDEN OR BASEMENT APT.
City	:	CHICAGO
State	:	IL
Zip	:	60660-1945
Country	:	US
Telephone Number	:	773-262-2647
Fax Number	:	773-262-2647

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	08/19/2011

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Directions to “ DR. MARK JAY BAILIN M.D.” Practice Location

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