Provider Demographics
NPI:1184886517
Name:DELOSSANTOS, GREGG MARTIN
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:MARTIN
Last Name:DELOSSANTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39671 TREASURY CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60694-9600
Mailing Address - Country:US
Mailing Address - Phone:773-533-5500
Mailing Address - Fax:773-533-0945
Practice Address - Street 1:2839 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1925
Practice Address - Country:US
Practice Address - Phone:773-533-5500
Practice Address - Fax:773-533-0945
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005158213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery