Healthcare Provider Details

I. General information

NPI: 1013180447
Provider Name (Legal Business Name): SETU A DALAL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 FRIST BLVD SUITE 204
FORT PIERCE FL
34950-4838
US

IV. Provider business mailing address

2402 FRIST BLVD SUITE 203
FORT PIERCE FL
34950-4838
US

V. Phone/Fax

Practice location:
  • Phone: 772-462-3939
  • Fax: 772-462-3938
Mailing address:
  • Phone: 772-462-3939
  • Fax: 772-462-3938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34.008816
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberOS 10402
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: