Provider Demographics
NPI:1801856117
Name:BALOCKI, JOHN S (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:BALOCKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:185 HERITAGE DRIVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014
Mailing Address - Country:US
Mailing Address - Phone:815-455-0310
Mailing Address - Fax:815-455-1210
Practice Address - Street 1:185 HERITAGE DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014
Practice Address - Country:US
Practice Address - Phone:815-455-0310
Practice Address - Fax:815-455-1210
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036073896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036073896Medicaid
IL080107933OtherRAILROAD MEDICARE
E19063Medicare UPIN
IL036073896Medicaid