Healthcare Provider Details

I. General information

NPI: 1679564462
Provider Name (Legal Business Name): CRAIG KENNETH DELIGDISH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 S APOLLO BLVD STE 303
MELBOURNE FL
32901-3332
US

IV. Provider business mailing address

1344 S APOLLO BLVD STE 406
MELBOURNE FL
32901-3185
US

V. Phone/Fax

Practice location:
  • Phone: 321-727-3495
  • Fax: 321-728-0226
Mailing address:
  • Phone: 321-727-2990
  • Fax: 321-724-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME53490
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME53490
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberME53490
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: