Basic Information
| Provider Information | |||||||||
| NPI: | 1477597342 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELADISMA | ||||||||
| FirstName: | MARCONI | ||||||||
| MiddleName: | DELEGERO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 N ROCKTON AVE | ||||||||
| Address2: | ROCKFORD HEALTH PHYSICIANS | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611033619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159712000 | ||||||||
| FaxNumber: | 8159719501 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 N ROCKTON AVE | ||||||||
| Address2: | ROCKFORD HEALTH PHYSICIANS | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611033619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159712000 | ||||||||
| FaxNumber: | 8159719501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 10/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 241377 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 63412 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036114984 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.