MEDICARE: DR. DOMENICK J SORRESSO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	ME77399	FL
2	207RP1001X	Pulmonary Disease Physician	MR77399	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	46527	OTHER		BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013917160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMENICK J SORRESSO M.D.

Provider Business Mailing Address
First Line	:	7614 JACQUE RD STE C
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34667-7195
Country	:	US
Telephone Number	:	727-857-5967
Fax Number	:	727-857-5972

Provider Business Practice Location Address
First Line	:	7614 JACQUE RD STE C
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34667-7195
Country	:	US
Telephone Number	:	727-857-5967
Fax Number	:	727-857-5972

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	04/01/2021

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