Provider Demographics
NPI:1740330737
Name:M & J AANESTHESIOLOGY LLC
Entity type:Organization
Organization Name:M & J AANESTHESIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-784-3700
Mailing Address - Street 1:1485 N ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3244
Mailing Address - Country:US
Mailing Address - Phone:321-784-3700
Mailing Address - Fax:321-784-4090
Practice Address - Street 1:220 N SYKES PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953
Practice Address - Country:US
Practice Address - Phone:321-784-3700
Practice Address - Fax:321-784-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065273261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42665BMedicare ID - Type UnspecifiedMEDICARE
FLF29337Medicare UPIN