Provider Demographics
NPI:1023044674
Name:ELALAOUI, SIDI A (MD)
Entity Type:Individual
Prefix:
First Name:SIDI
Middle Name:A
Last Name:ELALAOUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 N JOHN YOUNG PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-3221
Mailing Address - Country:US
Mailing Address - Phone:407-343-1284
Mailing Address - Fax:407-343-1286
Practice Address - Street 1:1952 N JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3221
Practice Address - Country:US
Practice Address - Phone:407-343-1284
Practice Address - Fax:407-343-1286
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252953000Medicaid
FL252953000Medicaid
FLG65663Medicare UPIN