MEDICARE: RAWAN BALOSH

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	104100000X	Social Worker	150.117063	IL

General Provider Information

NPI Number	:	1780525576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAWAN BALOSH

Provider Business Mailing Address
First Line	:	1212 S MICHIGAN AVE APT 2808
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2468
Country	:	US
Telephone Number	:	120-230-4678
Fax Number	:	120-230-4678

Provider Business Practice Location Address
First Line	:	1212 S MICHIGAN AVE APT 2808
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2468
Country	:	US
Telephone Number	:	202-304-6782
Fax Number	:

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

Provider Enumeration Date	:	04/03/2026
Last Update Date	:	04/05/2026

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Directions to “ RAWAN BALOSH ” Practice Location

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