Provider Demographics
NPI:1386644904
Name:INSTITUTE FOR UROLOGIC EXCELLENCE
Entity Type:Organization
Organization Name:INSTITUTE FOR UROLOGIC EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DELK
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:760-342-6657
Mailing Address - Street 1:81719 DR CARREON BLVD
Mailing Address - Street 2:POD C
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5518
Mailing Address - Country:US
Mailing Address - Phone:760-342-6657
Mailing Address - Fax:760-342-6658
Practice Address - Street 1:81719 DR CARREON BLVD
Practice Address - Street 2:POD C
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5518
Practice Address - Country:US
Practice Address - Phone:760-342-6657
Practice Address - Fax:760-342-6658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51415208800000X
CAC51286208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR57439Medicare ID - Type Unspecified
CAZZZ01548ZMedicare ID - Type Unspecified