Provider Demographics
NPI:1780663690
Name:DELLA VALLE, CRAIG J (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:J
Last Name:DELLA VALLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WESTBROOK CORPORATE CTR
Mailing Address - Street 2:#240
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1611 W HARRISON ST
Practice Address - Street 2:STE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-243-4244
Practice Address - Fax:312-942-1517
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105060207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105060Medicaid
7132441OtherAETNA
P00060740OtherRAILROAD MEDICARE
IL1633878OtherBCBS
IL207067OtherMEDICARE PTAN LOCALITY 16
DA4902OtherRAILROAD MEDICARE PTAN
IL207073OtherMEDICARE PTAN LOCALITY 15
ILH61093Medicare UPIN
ILK01330Medicare PIN
ILK01329Medicare PIN