Provider Demographics
NPI:1972607398
Name:DELISMA, KANSKY J (MD)
Entity type:Individual
Prefix:
First Name:KANSKY
Middle Name:J
Last Name:DELISMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 566264
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33256-6264
Mailing Address - Country:US
Mailing Address - Phone:305-325-0809
Mailing Address - Fax:305-456-3509
Practice Address - Street 1:4770 BISCAYNE BLVD
Practice Address - Street 2:150
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3202
Practice Address - Country:US
Practice Address - Phone:305-325-0809
Practice Address - Fax:305-456-3509
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME96104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277482800Medicaid
FL277482800Medicaid