Provider Demographics
NPI:1386670677
Name:BOTOMAN, VLAICU ALIN (MD)
Entity Type:Individual
Prefix:
First Name:VLAICU
Middle Name:ALIN
Last Name:BOTOMAN
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 1:2021 E COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3763
Mailing Address - Country:US
Mailing Address - Phone:954-202-7850
Mailing Address - Fax:954-202-7781
Practice Address - Street 1:2021 E COMMERCIAL BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:954-202-7850
Practice Address - Fax:954-202-7781
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67172207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3767655-00Medicaid
FLA06150Medicare UPIN
FL26282Medicare ID - Type Unspecified