Healthcare Provider Details

I. General information

NPI: 1649895962
Provider Name (Legal Business Name): MR. ALEXANDER THOMAS DELAKIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 N OAKLEY BLVD FL 3
CHICAGO IL
60622-3507
US

IV. Provider business mailing address

4241 N KENMORE AVE UNIT 110
CHICAGO IL
60613-1695
US

V. Phone/Fax

Practice location:
  • Phone: 312-770-2317
  • Fax:
Mailing address:
  • Phone: 715-563-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.025582
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: