Individual
DR. ANTOANETA Y BALABANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1725 W HARRISON ST, SUITE 1106, CHICAGO, IL 60612-3841
(312) 942-5936
(312) 942-2380
Mailing address
1653 W CONGRESS PKWY, SUITE 348 MURDOCK, CHICAGO, IL 60612-3833
(312) 942-6203
(312) 942-2238
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
036103242
IL
2084N0600X
Clinical Neurophysiology Physician
036103242
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036103242
—
IL
01
—
336064985
IL DEPT OF PROF REG
IL
01
—
BB7272432
US DEPT OF JUSTICE
—
Enumeration date
09/20/2005
Last updated
09/21/2011
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