Healthcare Provider Details

I. General information

NPI: 1194742015
Provider Name (Legal Business Name): YAKOV ILICH GITIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S CONGRESS AVE SUITE 211
ATLANTIS FL
33462-6635
US

IV. Provider business mailing address

5700 LAKE WORTH RD STE 204
LAKE WORTH FL
33463-3213
US

V. Phone/Fax

Practice location:
  • Phone: 561-964-8221
  • Fax: 561-964-7393
Mailing address:
  • Phone: 561-966-7707
  • Fax: 561-964-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME100527
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: