Provider Demographics
NPI:1154326775
Name:DELIKAT, TERRENCE (DO)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:
Last Name:DELIKAT
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 1:1350 E MAIN ST STE C-2
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-5064
Mailing Address - Country:US
Mailing Address - Phone:863-537-6151
Mailing Address - Fax:863-537-7146
Practice Address - Street 1:1350 E MAIN ST STE C-2
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-5064
Practice Address - Country:US
Practice Address - Phone:863-537-6151
Practice Address - Fax:863-537-7146
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2023-03-01
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
FLOS8368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264803200Medicaid
FL17407ZMedicare PIN
H68127Medicare UPIN