Provider Demographics
NPI:1649278946
Name:DELSOL, MANUEL (MD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:DELSOL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18900 N TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-7312
Mailing Address - Country:US
Mailing Address - Phone:239-567-1000
Mailing Address - Fax:239-567-1008
Practice Address - Street 1:18900 N TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-7312
Practice Address - Country:US
Practice Address - Phone:239-567-1000
Practice Address - Fax:239-567-1008
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75314207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262516400Medicaid
FL262516400Medicaid
G66124Medicare UPIN