Provider Demographics
NPI:1982958096
Name:DELTA HEALTHCARE INC
Entity Type:Organization
Organization Name:DELTA HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARKHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NUKEYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-226-4661
Mailing Address - Street 1:731 N SANGAMON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-5955
Mailing Address - Country:US
Mailing Address - Phone:312-226-4661
Mailing Address - Fax:312-962-4819
Practice Address - Street 1:731 N SANGAMON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-5955
Practice Address - Country:US
Practice Address - Phone:312-226-4661
Practice Address - Fax:312-962-4819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty