Provider Demographics
NPI:1194742015
Name:GITIN, YAKOV ILICH (MD)
Entity type:Individual
Prefix:
First Name:YAKOV
Middle Name:ILICH
Last Name:GITIN
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 1:5700 LAKE WORTH RD
Mailing Address - Street 2:STE 204
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3213
Mailing Address - Country:US
Mailing Address - Phone:561-966-7707
Mailing Address - Fax:561-964-4603
Practice Address - Street 1:5401 S CONGRESS AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6635
Practice Address - Country:US
Practice Address - Phone:561-964-8221
Practice Address - Fax:561-964-7393
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100527207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology