Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036-103388 | IL |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 036-103388 | IL |
NPI | 1326091414 |
---|---|
Provider Name | Serafin Deleon |
First Address | Des Plaines, IL 60016-2359 |
Second Address | Gurnee, IL 60031-5709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 01/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H98472 | (02) | IL |