Basic Information
| Provider Information | |||||||||
| NPI: | 1558543843 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TERRANCE S DELIKAT DO PL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 N LANIER AVE | ||||||||
| Address2: | |||||||||
| City: | FORT MEADE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338412918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632857171 | ||||||||
| FaxNumber: | 8632856701 | ||||||||
| Practice Location | |||||||||
| Address1: | 3650 INNOVATION DR | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338124105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636466295 | ||||||||
| FaxNumber: | 8637012151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | DELIKAT | ||||||||
| AuthorizedOfficialFirstName: | TERREANCE | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | DR | ||||||||
| AuthorizedOfficialTelephone: | 8632857171 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO PL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 264803200 | 05 | FL | MEDICAID |