Provider Demographics
NPI:1609067602
Name:DELAIN HEALTH GROUP
Entity Type:Organization
Organization Name:DELAIN HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:E
Authorized Official - Middle Name:
Authorized Official - Last Name:DELAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-872-5707
Mailing Address - Street 1:PO BOX 8564
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60079
Mailing Address - Country:US
Mailing Address - Phone:847-872-8602
Mailing Address - Fax:847-746-5892
Practice Address - Street 1:2456 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099
Practice Address - Country:US
Practice Address - Phone:847-872-5707
Practice Address - Fax:847-746-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C35878Medicare UPIN