Provider Demographics
NPI:1609068402
Name:BAILIN, MARK JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAY
Last Name:BAILIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6238 N MAGNOLIA AV.
Mailing Address - Street 2:GARDEN OR BASEMENT APT.
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1945
Mailing Address - Country:US
Mailing Address - Phone:773-262-2647
Mailing Address - Fax:773-262-2647
Practice Address - Street 1:6238 N MAGNOLIA AV.
Practice Address - Street 2:GARDEN OR BASEMENT APT.
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1945
Practice Address - Country:US
Practice Address - Phone:773-262-2647
Practice Address - Fax:773-262-2647
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-069-383208D00000X, 2083X0100X, 207P00000X, 208M00000X
IL036069383208VP0014X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine