Provider Demographics
NPI:1033142377
Name:ALALU, VITALY JAIME (MD)
Entity Type:Individual
Prefix:
First Name:VITALY
Middle Name:JAIME
Last Name:ALALU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 740177
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33474-0177
Mailing Address - Country:US
Mailing Address - Phone:561-740-2900
Mailing Address - Fax:561-434-0598
Practice Address - Street 1:6944 LAKE WORTH RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2948
Practice Address - Country:US
Practice Address - Phone:561-732-2900
Practice Address - Fax:561-740-9064
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME29180207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065172900Medicaid
D70610Medicare UPIN
FL065172900Medicaid