MEDICARE: CONSTANTINE GEOR DELIS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	036092711	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	01615184	OTHER	IL	BCBS
3	01621679	OTHER	IL	BCBS OF IL

General Provider Information

NPI Number	:	1003892043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANTINE GEOR DELIS DO

Provider Business Mailing Address
First Line	:	210 S DESPLAINES ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-5500
Country	:	US
Telephone Number	:	312-654-2700
Fax Number	:	312-654-9930

Provider Business Practice Location Address
First Line	:	675 W NORTH AVE STE 209
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1630
Country	:	US
Telephone Number	:	312-654-2744
Fax Number	:	708-338-1790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	07/28/2025

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Directions to “ CONSTANTINE GEOR DELIS DO” Practice Location

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