Provider Demographics
NPI:1356981708
Name:BALTRUKONIS, STEVE ZARIC
Entity type:Individual
Prefix:MR
First Name:STEVE
Middle Name:ZARIC
Last Name:BALTRUKONIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 SKOKIE BLVD STE 255
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4054
Mailing Address - Country:US
Mailing Address - Phone:312-870-0120
Mailing Address - Fax:
Practice Address - Street 1:4649 N KENTON AVE # 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-4019
Practice Address - Country:US
Practice Address - Phone:773-841-7693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL180016045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health