Provider Demographics
NPI:1225750193
Name:DELTA MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:DELTA MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KALID
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-658-0311
Mailing Address - Street 1:PO BOX 578220
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7303
Mailing Address - Country:US
Mailing Address - Phone:773-658-0311
Mailing Address - Fax:
Practice Address - Street 1:206 S NELTNOR BLVD
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-2847
Practice Address - Country:US
Practice Address - Phone:773-658-0311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-16
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty