MEDICARE: KAILI TEMPLE DILTS 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	207L00000X	Anesthesiology Physician	50799	CT

General Provider Information

NPI Number	:	1285877712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILI TEMPLE DILTS M.D.

Provider Business Mailing Address
First Line	:	7 WOODS END RD
Second Line	:
City	:	DARIEN
State	:	CT
Zip	:	06820-2908
Country	:	US
Telephone Number	:	917-494-2408
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 WASHINGTON BLVD
Second Line	:	SUITE 440
City	:	STAMFORD
State	:	CT
Zip	:	06901-2216
Country	:	US
Telephone Number	:	203-276-7490
Fax Number	:

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

Provider Enumeration Date	:	04/14/2009
Last Update Date	:	08/09/2012

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