Provider Demographics
NPI:1447394374
Name:BALODIS, ANITA (MD AAFP)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:
Last Name:BALODIS
Suffix:
Gender:F
Credentials:MD AAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126
Mailing Address - Country:US
Mailing Address - Phone:630-833-0280
Mailing Address - Fax:630-833-4803
Practice Address - Street 1:103 HAVEN RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:630-833-0280
Practice Address - Fax:630-833-4803
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL244410Medicare ID - Type Unspecified
D10188Medicare UPIN