Provider Demographics
NPI:1619258019
Name:DELGADILLO, JAMES L (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:DELGADILLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 OHM AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4616
Mailing Address - Country:US
Mailing Address - Phone:715-577-8234
Mailing Address - Fax:
Practice Address - Street 1:2009 OHM AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4616
Practice Address - Country:US
Practice Address - Phone:715-577-8234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-2199207R00000X
TNDOST 27207R00000X
WI57324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine