Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 36058033 | IL |
NPI | 1033224555 |
---|---|
Provider Name | Martin S Balin |
First Address | Chicago, IL 60657-5105 |
Second Address | Chicago, IL 60657-5105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03658033 | STATE LICENSE NUMBER (01) | IL |