Provider Demographics
NPI:1386809820
Name:DLX MEDICAL GROUP INC
Entity type:Organization
Organization Name:DLX MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALANIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-227-9594
Mailing Address - Street 1:461 N MULFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5190
Mailing Address - Country:US
Mailing Address - Phone:815-227-9594
Mailing Address - Fax:815-227-9574
Practice Address - Street 1:461 N MULFORD RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5190
Practice Address - Country:US
Practice Address - Phone:815-227-9594
Practice Address - Fax:815-227-9574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty