Provider Demographics
NPI:1457020703
Name:SOLTICE MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:SOLTICE MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DELIZO III
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-977-2101
Mailing Address - Street 1:4851 TAMIAMI TRL N STE 200
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3098
Mailing Address - Country:US
Mailing Address - Phone:773-977-2101
Mailing Address - Fax:
Practice Address - Street 1:4851 TAMIAMI TRL N STE 200
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3098
Practice Address - Country:US
Practice Address - Phone:773-977-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty