MEDICARE: DR. SEIDY IDALIS DELGADO PONS 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	208D00000X	General Practice Physician	16135	PR
2	208D00000X	General Practice Physician	ACN1319	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093827644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEIDY IDALIS DELGADO PONS M.D.

Provider Business Mailing Address
First Line	:	6675 WESTWOOD BLVD STE 475
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32821-6027
Country	:	US
Telephone Number	:	407-845-0330
Fax Number	:	888-972-1750

Provider Business Practice Location Address
First Line	:	3372 W SOUTHPORT RD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-2706
Country	:	US
Telephone Number	:	407-933-7900
Fax Number	:	321-437-0072

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	05/30/2023

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