Healthcare Provider Details

I. General information

NPI: 1134177447
Provider Name (Legal Business Name): ARISTIDES DELAHERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 SILVER CROSS BLVD STE 240
NEW LENOX IL
60451-9528
US

IV. Provider business mailing address

1860 PAYSPHERE CIR
CHICAGO IL
60674-6549
US

V. Phone/Fax

Practice location:
  • Phone: 815-740-1900
  • Fax: 815-485-4469
Mailing address:
  • Phone: 630-469-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036076536
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036076536
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: