Provider Demographics
NPI:1770666158
Name:ALILIN, ELEUTERIO ROGER SR (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEUTERIO
Middle Name:ROGER
Last Name:ALILIN
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ELEUTERIO
Other - Middle Name:ROGER
Other - Last Name:ALILIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7221 ALOMA AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-7119
Mailing Address - Country:US
Mailing Address - Phone:407-657-2111
Mailing Address - Fax:407-679-2906
Practice Address - Street 1:7221 ALOMA AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-7119
Practice Address - Country:US
Practice Address - Phone:407-657-2111
Practice Address - Fax:407-679-2906
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54774Medicare UPIN
FL42110ZMedicare ID - Type Unspecified