Basic Information
| Provider Information | |||||||||
| NPI: | 1952557316 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALEK | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 808 E WOODFIELD RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601734836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476050030 | ||||||||
| FaxNumber: | 8476370737 | ||||||||
| Practice Location | |||||||||
| Address1: | 7035 NORTH AVE | ||||||||
| Address2: | |||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603021015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086803800 | ||||||||
| FaxNumber: | 7083833665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2008 | ||||||||
| LastUpdateDate: | 12/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207UN0901X | 036138469 | IL | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 207RC0000X | 036138469 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 036138469 | 05 | IL | MEDICAID |