MEDICARE: MIRATIQULLAH HESSAMI MD

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	207R00000X	Internal Medicine Physician	ME 81337	FL

General Provider Information

NPI Number	:	1629077573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRATIQULLAH HESSAMI MD

Provider Business Mailing Address
First Line	:	33425 E LAKE JOANNA DR
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32736-7249
Country	:	US
Telephone Number	:	352-223-5244
Fax Number	:	352-735-4262

Provider Business Practice Location Address
First Line	:	33425 E LAKE JOANNA DR
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32736-7249
Country	:	US
Telephone Number	:	352-223-5244
Fax Number	:	352-735-4262

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/24/2014

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