Individual
GRANT THEODORE BALBARIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4201 W CHASE AVE, LINCOLNWOOD, IL 60712-1935
(847) 287-4666
Mailing address
4201 W CHASE AVE, LINCOLNWOOD, IL 60712-1935
(847) 287-4666
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.331615
IL
367500000X
Certified Registered Nurse Anesthetist
112318430
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
209015171
IL
Other
Enumeration date
11/06/2016
Last updated
03/18/2026
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