Provider Demographics
NPI:1245369685
Name:BALANDRIN, JORGE ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ENRIQUE
Last Name:BALANDRIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10621 PALOS WEST DR
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1598
Mailing Address - Country:US
Mailing Address - Phone:708-448-1476
Mailing Address - Fax:
Practice Address - Street 1:4700 W 95TH ST STE 308
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2572
Practice Address - Country:US
Practice Address - Phone:708-424-1222
Practice Address - Fax:708-229-2355
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036070483207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C48076Medicare UPIN