MEDICARE: DR. TRIFON DALKALITSIS M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	ME 32036	FL

General Provider Information

NPI Number	:	1750653820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRIFON DALKALITSIS M. D.

Provider Business Mailing Address
First Line	:	2565 S PLEASANT PT
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34450-6201
Country	:	US
Telephone Number	:	353-726-3828
Fax Number	:	352-726-3828

Provider Business Practice Location Address
First Line	:	2565 S PLEASANT PT
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34450-6201
Country	:	US
Telephone Number	:	352-726-3828
Fax Number	:	352-726-3828

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2012
Last Update Date	:	02/03/2012

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