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General NPI Number Information
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NPI Number | 1346301645
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Entity Type | Individual
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Provider Name | ERNESTO HERMOSILLA BEDIA M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 43565 ELIZABETH ST
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-1034
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Country | US
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Telephone | 586-307-9611
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Fax |
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Provider Business Mailing Address
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Address Line | 809 PINE THISTLE LN
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-2017
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Country | US
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Telephone | 248-646-1716
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5315025174
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License Number State | MI
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