Healthcare Provider Details

I. General information

NPI: 1750322392
Provider Name (Legal Business Name): JOSE V DELEON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 PRINCETON LANE
GLENVIEW IL
60026-5950
US

IV. Provider business mailing address

104 PRINCETON LANE
GLENVIEW IL
60026-5950
US

V. Phone/Fax

Practice location:
  • Phone: 312-909-2881
  • Fax: 773-292-8283
Mailing address:
  • Phone: 312-909-2881
  • Fax: 773-292-8283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036047845
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036047845
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: