Provider Demographics
NPI:1366571945
Name:MARIA BALKOURA MD SC
Entity type:Organization
Organization Name:MARIA BALKOURA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BALKOURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-944-3857
Mailing Address - Street 1:1. E. SUPERIOR ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2594
Mailing Address - Country:US
Mailing Address - Phone:312-944-3857
Mailing Address - Fax:312-944-8404
Practice Address - Street 1:1. E. SUPERIOR ST
Practice Address - Street 2:SUITE 210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2594
Practice Address - Country:US
Practice Address - Phone:312-944-3857
Practice Address - Fax:312-944-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36042786Medicaid
IL36042786Medicaid