Healthcare Provider Details

I. General information

NPI: 1821908393
Provider Name (Legal Business Name): IVAN DELGADO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 W MADISON ST
CHICAGO IL
60602-4309
US

IV. Provider business mailing address

4705 W SCHUBERT AVE
CHICAGO IL
60639-1842
US

V. Phone/Fax

Practice location:
  • Phone: 773-553-1800
  • Fax:
Mailing address:
  • Phone: 773-614-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.040211
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: