Provider Demographics
NPI:1063531804
Name:WILLS, DELINDA DEMITA (MD)
Entity type:Individual
Prefix:MS
First Name:DELINDA
Middle Name:DEMITA
Last Name:WILLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 TURTLE CREEK BLVD APT 1534
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5484
Mailing Address - Country:US
Mailing Address - Phone:318-401-0911
Mailing Address - Fax:386-226-3371
Practice Address - Street 1:221 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61636-0001
Practice Address - Country:US
Practice Address - Phone:309-672-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361638052086S0102X
TXS85052086S0102X, 261QM2500X, 207RC0200X
FL122738282NC0060X
AZ540292086S0102X
FLME1227382086S0102X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine