MEDICARE: DELOS CLIFT MD PA

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	2086S0129X	Vascular Surgery Physician	ME60789	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2068831	OTHER	FL	AETNA HMO
2	2380840009	OTHER	FL	CIGNA
3	12931	OTHER	FL	BLUE CROSS/BLUE SHIELD
4	A004	OTHER	FL	TRICARE
5	211537	OTHER	FL	AVMED

General Provider Information

NPI Number	:	1548210180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELOS CLIFT MD PA

Provider Business Mailing Address
First Line	:	3000 N ORANGE AVE
Second Line	:	SUITE A
City	:	ORLANDO
State	:	FL
Zip	:	32804-7613
Country	:	US
Telephone Number	:	407-472-0840
Fax Number	:	407-472-0841

Provider Business Practice Location Address
First Line	:	3000 N ORANGE AVE
Second Line	:	SUITE A
City	:	ORLANDO
State	:	FL
Zip	:	32804-7613
Country	:	US
Telephone Number	:	407-472-0840
Fax Number	:	407-472-0841

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CATHY BENITEZ
Credential	:
Telephone Number	:	407-472-0840

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	04/10/2008

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Directions to “DELOS CLIFT MD PA ” Practice Location

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