Provider Demographics
NPI:1679564462
Name:DELIGDISH, CRAIG KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:KENNETH
Last Name:DELIGDISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1344 S APOLLO BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3185
Mailing Address - Country:US
Mailing Address - Phone:321-727-2990
Mailing Address - Fax:321-724-0455
Practice Address - Street 1:1344 S APOLLO BLVD
Practice Address - Street 2:STE 303
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3332
Practice Address - Country:US
Practice Address - Phone:321-727-3495
Practice Address - Fax:321-728-0226
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME53490207RH0000X, 207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPR06668OtherQUALITY HEALTH PLANS
FL07510OtherBLUE CROSS AND BLUE SHIELD
1034687OtherCAREPLUS
FL4334053OtherAETNA
FL6340075002OtherCIGNA
FL830007236OtherRAILROAD MEDICARE
FLEFFECTIVE 04/01/1999OtherCCN/FIRST HEALTH
FL0081989OtherAETNA
FL024275000Medicaid
FL01226665OtherAMERIGROUP
FL03716OtherWELLCARE
FLPR06668OtherQUALITY HEALTH PLANS
FL07510YMedicare PIN