Active NPI
David L Deloso, MD
- Pediatrics Physician
- Mount Vernon, IL
National Provider Identifier
1912002882
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036089974
- Practice address
- 2920 Veterans Memorial Dr
Mount Vernon, IL 62864-5924 - Phone
- (618) 244-6544
- Fax
- (618) 244-6577
- NPI assigned
- Sep 14, 2006
- Last updated
- Jun 7, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036089974 | IL | Primary |
Addresses
Primary practice location
2920 Veterans Memorial Dr
Mount Vernon, IL 62864-5924
Mailing address
PO Box 155
Christopher, IL 62822-0155
Phone (618) 724-1624
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036089974 | Medicaid | IL | |
| 4106916 | Other | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036089974 | IL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559865600000",
"number": "1912002882",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 155",
"city": "CHRISTOPHER",
"state": "IL",
"postal_code": "628220155",
"telephone_number": "618-724-1624",
"fax_number": "618-724-4628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2920 VETERANS MEMORIAL DR",
"city": "MOUNT VERNON",
"state": "IL",
"postal_code": "628645924",
"telephone_number": "618-244-6544",
"fax_number": "618-244-6577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELOSO",
"first_name": "DAVID",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2019-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036089974",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036089974",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "4106916",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, IL
- Deaconess Illinois Specialty Clinic, Inc. (Deaconess IL Specialty 4113 Water Tower)
- Deaconess Illinois Specialty Clinic, Inc. (Deaconess IL Specialty Express Broadway St)
- Deaconess Illinois Specialty Clinic, Inc. (Deaconess IL Specialty Doctors Park)
- Deaconess Illinois Specialty Clinic, Inc. (Deaconess Illinois Specialty Clinic Occupational Health Broadway)
- Deaconess Illinois Specialty Clinic, Inc. (Deaconess IL Specialty Good Samaritan)
- Vivian V Deloso, OT
- Joseph Demattei, PHARM.D.
- Dennis P Mlot MD LLC
- Meenakshi M Desai, MD FACS
- Developmental Planning & Services Inc (Oak Terrace)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.