Provider Demographics
NPI:1750393286
Name:DELIS, JAMES GEORGE (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GEORGE
Last Name:DELIS
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 1:635 N FAIRBANKS CT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5435
Mailing Address - Country:US
Mailing Address - Phone:312-472-3173
Mailing Address - Fax:312-472-3176
Practice Address - Street 1:635 N FAIRBANKS CT
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5435
Practice Address - Country:US
Practice Address - Phone:312-472-3173
Practice Address - Fax:312-472-3173
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-091115207Q00000X
IL036091115202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400355168OtherMEDICARE PTAN
ILF400355167OtherMEDICARE PTAN