Provider Demographics
NPI:1588015184
Name:DE, DEBALINA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBALINA
Middle Name:
Last Name:DE
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 1:600 N KINGSBURY ST APT 707
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8121
Mailing Address - Country:US
Mailing Address - Phone:314-974-5105
Mailing Address - Fax:
Practice Address - Street 1:259 E ERIE ST STE 2150
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3370
Practice Address - Country:US
Practice Address - Phone:312-926-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.068850207R00000X
IL036.150749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine