Provider Demographics
NPI:1063508075
Name:DELGADO, KRISTINE C (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:C
Last Name:DELGADO
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 1:200 E 115TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-5015
Mailing Address - Country:US
Mailing Address - Phone:177-346-8305
Mailing Address - Fax:
Practice Address - Street 1:200 E 115TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-5015
Practice Address - Country:US
Practice Address - Phone:312-747-9443
Practice Address - Fax:312-747-9447
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine