Provider Demographics
NPI:1033201058
Name:DILELLA, CARL P (DO)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:P
Last Name:DILELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 36TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6587
Mailing Address - Country:US
Mailing Address - Phone:772-778-2009
Mailing Address - Fax:772-778-1895
Practice Address - Street 1:1285 36TH ST STE 100
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6587
Practice Address - Country:US
Practice Address - Phone:772-778-2009
Practice Address - Fax:772-778-1895
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9582207XX0005X
FLOS13249207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI07501Medicare UPIN
IL036110951Medicare ID - Type Unspecified