Provider Demographics
NPI:1235122813
Name:DELGADO, ALBERTO L (MD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:L
Last Name:DELGADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:SUITE 130-PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:217-443-2113
Mailing Address - Fax:317-962-4343
Practice Address - Street 1:1200 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3517
Practice Address - Country:US
Practice Address - Phone:309-268-2182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066289207Q00000X
IL036-066289207P00000X
IN01032649A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100008440Medicaid
IN000000606443OtherANTHEM BCBS
IL036066289-7Medicaid
IL036066289OtherBLUE SHIELD
IL036066289Medicaid
IL036066289-1Medicaid
IL036066289OtherBLUE SHIELD
IL036066289-1Medicaid
IL036066289-7Medicaid
IN131180WWWMedicare PIN