Provider Demographics
NPI:1851352322
Name:LALLI, DAVID ADAM (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ADAM
Last Name:LALLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2954 MALLORY CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1820
Mailing Address - Country:US
Mailing Address - Phone:321-939-0222
Mailing Address - Fax:407-288-1996
Practice Address - Street 1:2954 MALLORY CIR STE 101
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-1820
Practice Address - Country:US
Practice Address - Phone:321-939-0222
Practice Address - Fax:407-288-1996
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS13865207XX0005X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593523727OtherGROUP TAX ID