Provider Demographics
NPI:1013180447
Name:DALAL, SETU A (DO)
Entity Type:Individual
Prefix:DR
First Name:SETU
Middle Name:A
Last Name:DALAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 FRIST BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4838
Mailing Address - Country:US
Mailing Address - Phone:772-462-3939
Mailing Address - Fax:772-462-3938
Practice Address - Street 1:2402 FRIST BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4838
Practice Address - Country:US
Practice Address - Phone:772-462-3939
Practice Address - Fax:772-462-3938
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008816208600000X
FLOS 104022086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00691798OtherRR MEDICARE
FL000431300Medicaid
FLP00691798OtherRR MEDICARE