MEDICARE: DR. EDDIE RESQUITES HERMOSISIMA 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	207QA0505X	Adult Medicine Physician	23031	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902807068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDDIE RESQUITES HERMOSISIMA M.D.

Provider Business Mailing Address
First Line	:	707 S MAIN ST
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28081-4915
Country	:	US
Telephone Number	:	704-933-1151
Fax Number	:	704-933-1155

Provider Business Practice Location Address
First Line	:	707 S MAIN ST
Second Line	:
City	:	KANNAPOLIS
State	:	NC
Zip	:	28081-4915
Country	:	US
Telephone Number	:	704-933-1151
Fax Number	:	704-933-1155

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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