Basic Information
| Provider Information | |||||||||
| NPI: | 1083697171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELEOZ | ||||||||
| FirstName: | JOY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 698 FEATHERSTONE RD | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611076303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153983277 | ||||||||
| FaxNumber: | 8154847001 | ||||||||
| Practice Location | |||||||||
| Address1: | 698 FEATHERSTONE RD | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611076303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153983277 | ||||||||
| FaxNumber: | 8154847001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 12/28/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036112801 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036112801 | 05 | IL | MEDICAID |