Provider Demographics
NPI:1154398303
Name:PILUIKO, VITALY (MD)
Entity type:Individual
Prefix:
First Name:VITALY
Middle Name:
Last Name:PILUIKO
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 1:2137 SEDONA HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4135
Mailing Address - Country:US
Mailing Address - Phone:786-375-0622
Mailing Address - Fax:
Practice Address - Street 1:1893 KINGSLEY AVE
Practice Address - Street 2:STE A
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:904-592-4940
Practice Address - Fax:904-400-6673
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL109452208G00000X, 208G00000X
NMMD2019-0519208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004424700Medicaid
FLP01593698OtherMEDICARE RAILROAD
FL004424700Medicaid
FLFM155UMedicare PIN