Provider Demographics
NPI:1598712937
Name:DELIDUKA, STEVEN BAXTER (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BAXTER
Last Name:DELIDUKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:1170 E BELVIDERE RD STE 206
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2076
Practice Address - Country:US
Practice Address - Phone:224-541-8120
Practice Address - Fax:224-541-8121
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.118712207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH50728Medicare UPIN
GA050972Medicare ID - Type Unspecified