MEDICARE: KANSKY J DELISMA MD

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	207R00000X	Internal Medicine Physician	ME96104	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	:	1972607398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANSKY J DELISMA MD

Provider Business Mailing Address
First Line	:	PO BOX 566264
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33256-6264
Country	:	US
Telephone Number	:	305-325-0809
Fax Number	:	305-456-3509

Provider Business Practice Location Address
First Line	:	4770 BISCAYNE BLVD
Second Line	:	150
City	:	MIAMI
State	:	FL
Zip	:	33137-3202
Country	:	US
Telephone Number	:	305-325-0809
Fax Number	:	305-456-3509

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

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	09/24/2014

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