Provider Demographics
NPI:1689220527
Name:DELO SPORT AND STEM SC
Entity Type:Organization
Organization Name:DELO SPORT AND STEM SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DELO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-632-7248
Mailing Address - Street 1:2595 DEVELOPMENT DR STE 140
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-4267
Mailing Address - Country:US
Mailing Address - Phone:920-632-7248
Mailing Address - Fax:920-632-4249
Practice Address - Street 1:2595 DEVELOPMENT DR STE 140
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-4267
Practice Address - Country:US
Practice Address - Phone:920-632-7248
Practice Address - Fax:920-632-4249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty