Provider Demographics
NPI:1063836328
Name:DELGADILLO, LOUIS SR (DPM)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:DELGADILLO
Suffix:SR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 SCOTTSDALE DR
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-5400
Mailing Address - Country:US
Mailing Address - Phone:224-990-6037
Mailing Address - Fax:
Practice Address - Street 1:864 SCOTTSDALE DR
Practice Address - Street 2:
Practice Address - City:PINGREE GROVE
Practice Address - State:IL
Practice Address - Zip Code:60140-5400
Practice Address - Country:US
Practice Address - Phone:224-990-6037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL316.000933213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist