Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 036092711 | IL |
NPI | 1003892043 |
---|---|
Provider Name | Constantine G Delis |
First Address | Chicago, IL 60661-5500 |
Second Address | Melrose Park, IL 60160-4138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01615184 | BCBS (01) | IL |
01621679 | BCBS OF IL (01) | IL |
036092711 | (05) | IL |
G 85449 | (02) | IL |