Provider Demographics
NPI:1639158314
Name:BAHK, JANE K (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:K
Last Name:BAHK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E CHESTNUT ST
Mailing Address - Street 2:UNIT 612
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 ERIE CT
Practice Address - Street 2:SUITE 6140
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2566
Practice Address - Country:US
Practice Address - Phone:708-848-2400
Practice Address - Fax:708-445-8269
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102713207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK46497OtherMEDICARE PROVIDER NUMBER
IL036102713Medicaid
IL180041057OtherRAILROAD MEDICARE
IL0031600193OtherBLUE SHIELD
3970320001Medicare NSC
IL0031600193OtherBLUE SHIELD
IL587570Medicare ID - Type Unspecified