Provider Demographics
NPI:1063566487
Name:DELIS FAMILY MEDICAL, S.C.
Entity type:Organization
Organization Name:DELIS FAMILY MEDICAL, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:DELIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:312-593-0713
Mailing Address - Street 1:4116 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7545
Mailing Address - Country:US
Mailing Address - Phone:847-205-1464
Mailing Address - Fax:847-205-1464
Practice Address - Street 1:2740 W FOSTER AVE
Practice Address - Street 2:STE. 316
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3500
Practice Address - Country:US
Practice Address - Phone:773-561-8481
Practice Address - Fax:773-561-8495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG79164Medicare UPIN