Provider Demographics
NPI:1255314357
Name:DALEO, JAMES A (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:DALEO
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 1:7634 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3110
Mailing Address - Country:US
Mailing Address - Phone:773-589-1677
Mailing Address - Fax:773-589-1688
Practice Address - Street 1:7107 W BELMONT AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4688
Practice Address - Country:US
Practice Address - Phone:773-622-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064448207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064448Medicaid
IL036064448Medicaid
ILK12355Medicare UPIN