Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 316.000933 | IL |
Y | 222Z00000X | Podiatrist | 316.000933 | IL |
NPI | 1063836328 |
---|---|
Provider Name | Louis Delgadillo SR. |
First Address | Pingree Grove, IL 60140-5400 |
Second Address | Pingree Grove, IL 60140-5400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2014 |
Last Update Date | 06/02/2014 |