Healthcare Provider Details

I. General information

NPI: 1558543843
Provider Name (Legal Business Name): TERRENCE S. DELIKAT, DO, P.L.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 E MAIN ST STE C-2
BARTOW FL
33830-5064
US

IV. Provider business mailing address

1350 E MAIN ST STE C-2
BARTOW FL
33830-5064
US

V. Phone/Fax

Practice location:
  • Phone: 863-537-6151
  • Fax: 863-537-7146
Mailing address:
  • Phone: 863-537-6151
  • Fax: 863-537-7146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. TERRENCE DELIKAT
Title or Position: DR
Credential: DO PL
Phone: 863-537-6151