Healthcare Provider Details

I. General information

NPI: 1972819944
Provider Name (Legal Business Name): ANTON MICAEL DELA CRUZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HICKORY ST
MELBOURNE FL
32901-3224
US

IV. Provider business mailing address

10299 SOUTHERN BLVD UNIT 212773
ROYAL PALM BEACH FL
33421-5112
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-4225
  • Fax:
Mailing address:
  • Phone: 860-389-8956
  • Fax: 860-679-1621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number229882
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: