Healthcare Provider Details

I. General information

NPI: 1235122813
Provider Name (Legal Business Name): ALBERTO L. DELGADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 FRANKLIN AVE
NORMAL IL
61761-3517
US

IV. Provider business mailing address

250 N SHADELAND AVE SUITE 130-PROVIDER ENROLLMENT
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 309-268-2182
  • Fax:
Mailing address:
  • Phone: 217-443-2113
  • Fax: 317-962-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036066289
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-066289
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01032649A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: