Provider Demographics
NPI:1972738599
Name:BALCI, GAMZE (MD)
Entity Type:Individual
Prefix:
First Name:GAMZE
Middle Name:
Last Name:BALCI
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 1:2333 WAUKEGAN RD STE 150
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1563
Mailing Address - Country:US
Mailing Address - Phone:224-804-9220
Mailing Address - Fax:
Practice Address - Street 1:2333 WAUKEGAN RD STE 150
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1563
Practice Address - Country:US
Practice Address - Phone:224-804-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN555482084P0800X, 2084P0800X
DC204552084P0800X
MN1064152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN260003746Medicare PIN
FLHL020ZMedicare PIN