Provider Demographics
NPI:1003892043
Name:DELIS, CONSTANTINE G (DO)
Entity Type:Individual
Prefix:
First Name:CONSTANTINE
Middle Name:G
Last Name:DELIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 S DESPLAINES ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5500
Mailing Address - Country:US
Mailing Address - Phone:312-654-2700
Mailing Address - Fax:312-654-9930
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4138
Practice Address - Country:US
Practice Address - Phone:708-338-1780
Practice Address - Fax:708-338-1790
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036092711207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01615184OtherBCBS
IL036092711Medicaid
IL01621679OtherBCBS OF IL
IL207831Medicare ID - Type UnspecifiedGROUP 950150
IL01621679OtherBCBS OF IL
IL036092711Medicaid