MEDICARE: DR. GREGG MARTIN DELOSSANTOS

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	213ES0103X	Foot & Ankle Surgery Podiatrist	016005158	IL

General Provider Information

NPI Number	:	1184886517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGG MARTIN DELOSSANTOS

Provider Business Mailing Address
First Line	:	39671 TREASURY CTR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60694-9600
Country	:	US
Telephone Number	:	773-533-5500
Fax Number	:	773-533-0945

Provider Business Practice Location Address
First Line	:	2839 W MADISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1925
Country	:	US
Telephone Number	:	773-533-5500
Fax Number	:	773-533-0945

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

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	04/07/2023

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Directions to “ DR. GREGG MARTIN DELOSSANTOS ” Practice Location

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