1164417986 NPI number — DR. EDDIE BARTOLOMEI M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164417986 NPI number — DR. EDDIE BARTOLOMEI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTOLOMEI
Provider First Name:
EDDIE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BARTOLOMEI VAZQUEZ
Provider Other First Name:
EDDIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164417986
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/23/2006
NPI Reactivation Date:
04/03/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11687 VICOLO LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDERMERE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34786-6054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-497-6623
Provider Business Mailing Address Fax Number:
248-926-0176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11687 VICOLO LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDERMERE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34786-6054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-497-6623
Provider Business Practice Location Address Fax Number:
248-926-0176
Provider Enumeration Date:
09/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  4301064370 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 103439403 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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