Basic Information
| Provider Information | |||||||||
| NPI: | 1245541374 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEN BARAK | ||||||||
| FirstName: | MOR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5616 N WINTHROP AVE APT 1F | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606604420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086917706 | ||||||||
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| Practice Location | |||||||||
| Address1: | 420 E SUPERIOR ST FL 12 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606114494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125037975 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2010 | ||||||||
| LastUpdateDate: | 09/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 125058326 | IL | N | Allopathic & Osteopathic Physicians | Surgery | 207L00000X | 036138016 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.