Healthcare Provider Details

I. General information

NPI: 1730863549
Provider Name (Legal Business Name): CARSON MICHELLE DELGADILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 JOHN DEERE RD STE 200
MOLINE IL
61265-6897
US

IV. Provider business mailing address

600 JOHN DEERE RD STE 200
MOLINE IL
61265-6897
US

V. Phone/Fax

Practice location:
  • Phone: 309-779-4310
  • Fax:
Mailing address:
  • Phone: 309-779-4310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number085.011309
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number085011309
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: