Provider Demographics
NPI:1730463282
Name:BALABANOVA, TANIA S (MD)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:S
Last Name:BALABANOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:BEDFORD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60499-0443
Mailing Address - Country:US
Mailing Address - Phone:708-831-8282
Mailing Address - Fax:773-714-1229
Practice Address - Street 1:8420 W BRYN MAWR AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3436
Practice Address - Country:US
Practice Address - Phone:708-831-8282
Practice Address - Fax:773-714-1229
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI56342-20207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology