Provider Demographics
NPI:1720086481
Name:BALKOURA, MARIA H (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:H
Last Name:BALKOURA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 E SUPERIOR ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2507
Mailing Address - Country:US
Mailing Address - Phone:312-944-3857
Mailing Address - Fax:312-944-8404
Practice Address - Street 1:1 E SUPERIOR ST
Practice Address - Street 2:SUITE 210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2507
Practice Address - Country:US
Practice Address - Phone:312-944-3857
Practice Address - Fax:312-944-8404
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK35735Medicare PIN