Individual
JOHN M. BAILITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
211 E. ONTARIO ST., NORTHWESTERN MEDICINE, CHICAGO, IL 60611
(312) 694-7000
(312) 926-6274
Mailing address
680 N LAKE SHORE DR, CHICAGO, IL 60611-4546
(312) 695-9797
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036105881
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036105881
ILLINOIS LICENSE
IL
Enumeration date
08/02/2005
Last updated
05/10/2017
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