Provider Demographics
NPI:1811377864
Name:DELISCA, GADINI (MD)
Entity Type:Individual
Prefix:
First Name:GADINI
Middle Name:
Last Name:DELISCA
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 1:900 N 2ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-1764
Mailing Address - Country:US
Mailing Address - Phone:815-562-3784
Mailing Address - Fax:815-561-3149
Practice Address - Street 1:900 N 2ND ST STE 200
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-1764
Practice Address - Country:US
Practice Address - Phone:815-562-3784
Practice Address - Fax:815-561-3149
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4601107797207X00000X
IL036154620207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery