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1881688638

NPI Code Detail

MEDICARE: DR. BRIAN MICHAEL BABKA MD

MEDICARE: DR. BRIAN MICHAEL BABKA MD

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	207QS0010X	Sports Medicine (Family Medicine) Physician	036105650	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0222075	OTHER	IL	BLUE CROSS GROUP ID
2	3631498336019001	OTHER	IL	CDPG HFS PAYEE ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881688638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN MICHAEL BABKA MD

Provider Business Mailing Address
First Line	:	27650 FERRY RD
Second Line	:
City	:	WARRENVILLE
State	:	IL
Zip	:	60555-3845
Country	:	US
Telephone Number	:	630-225-2663
Fax Number	:	630-225-2399

Provider Business Practice Location Address
First Line	:	27650 FERRY RD
Second Line	:
City	:	WARRENVILLE
State	:	IL
Zip	:	60555-3845
Country	:	US
Telephone Number	:	630-225-2663
Fax Number	:	630-225-2399

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	12/09/2014

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Directions to “ DR. BRIAN MICHAEL BABKA MD” Practice Location

Language	Start Address	Practice Location

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